Provider Demographics
NPI:1033438569
Name:DELEAULT, JESSICA (LCMHC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:DELEAULT
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 CENTRE ST
Mailing Address - Street 2:SUITE #2
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-6302
Mailing Address - Country:US
Mailing Address - Phone:603-228-7300
Mailing Address - Fax:
Practice Address - Street 1:8 CENTRE ST
Practice Address - Street 2:SUITE #2
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-6302
Practice Address - Country:US
Practice Address - Phone:603-228-7300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-24
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH631101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health