Provider Demographics
NPI:1245790120
Name:DIRKS, JESSICA AMBER (LCSW)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:AMBER
Last Name:DIRKS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 W CIVIC CENTER DR STE 200
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701-4052
Mailing Address - Country:US
Mailing Address - Phone:714-795-3444
Mailing Address - Fax:714-795-3445
Practice Address - Street 1:615 W CIVIC CENTER DR STE 200
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-4052
Practice Address - Country:US
Practice Address - Phone:714-795-3444
Practice Address - Fax:714-795-3445
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-25
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA972621041C0700X
CALCSW97262104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical