Provider Demographics
NPI:1144618083
Name:ENABULELE, JOCELYN
Entity Type:Individual
Prefix:DR
First Name:JOCELYN
Middle Name:
Last Name:ENABULELE
Suffix:
Gender:F
Credentials:
Other - Prefix:PROF
Other - First Name:JOCELYN
Other - Middle Name:
Other - Last Name:ENABULELE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:EDD
Mailing Address - Street 1:PO BOX 3810
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98213-8810
Mailing Address - Country:US
Mailing Address - Phone:281-630-1032
Mailing Address - Fax:
Practice Address - Street 1:19105 WAXEN ROAD
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98012
Practice Address - Country:US
Practice Address - Phone:281-630-1032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-30
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG60524424101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health