Provider Demographics
NPI:1679995278
Name:EPPLEY, JESSEE SHANE (LMFTA)
Entity type:Individual
Prefix:MR
First Name:JESSEE
Middle Name:SHANE
Last Name:EPPLEY
Suffix:
Gender:M
Credentials:LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8029 CORPORATE CENTER DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-4547
Mailing Address - Country:US
Mailing Address - Phone:615-218-7276
Mailing Address - Fax:
Practice Address - Street 1:8029 CORPORATE CENTER DR
Practice Address - Street 2:SUITE 100
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-4547
Practice Address - Country:US
Practice Address - Phone:615-218-7276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-16
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9056A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist