Provider Demographics
NPI:1407520661
Name:COLLADO, JESSICA VANESSA (MA, LLPC)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:VANESSA
Last Name:COLLADO
Suffix:
Gender:F
Credentials:MA, LLPC
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:VANESSA
Other - Last Name:COLLADO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LLPC
Mailing Address - Street 1:29802 ROSEBRIAR ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48082-2634
Mailing Address - Country:US
Mailing Address - Phone:586-746-4345
Mailing Address - Fax:
Practice Address - Street 1:1777 AXTELL DR STE 100
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-4400
Practice Address - Country:US
Practice Address - Phone:248-787-0855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-02
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451018299101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health