Provider Demographics
NPI:1407482326
Name:DELL, JESSICA DEVON (CDCA II)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:DEVON
Last Name:DELL
Suffix:
Gender:F
Credentials:CDCA II
Other - Prefix:
Other - First Name:JESSCA
Other - Middle Name:DEVON
Other - Last Name:MCCARTHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3622 BELMONT AVE STE 21
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44505-1444
Mailing Address - Country:US
Mailing Address - Phone:234-719-1885
Mailing Address - Fax:
Practice Address - Street 1:3622 BELMONT AVE STE 21
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44505-1444
Practice Address - Country:US
Practice Address - Phone:234-719-1885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-23
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.167724101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)