Provider Demographics
NPI:1255843454
Name:DEVILLE, JESSIE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JESSIE
Middle Name:
Last Name:DEVILLE
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 1:124 S 13TH ST BLDG 2
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:LA
Mailing Address - Zip Code:71463-2935
Mailing Address - Country:US
Mailing Address - Phone:866-530-6111
Mailing Address - Fax:
Practice Address - Street 1:124 S 13TH ST BLDG 2
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:LA
Practice Address - Zip Code:71463-2935
Practice Address - Country:US
Practice Address - Phone:318-215-1413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-27
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA123481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical