Provider Demographics
NPI:1467670455
Name:DORESTIN, JUNISE JEAN-GILLES (COUNSELOR MENTAL HEA)
Entity Type:Individual
Prefix:MRS
First Name:JUNISE
Middle Name:JEAN-GILLES
Last Name:DORESTIN
Suffix:
Gender:F
Credentials:COUNSELOR MENTAL HEA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30755-B AULD RD
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-7229
Mailing Address - Country:US
Mailing Address - Phone:951-696-3112
Mailing Address - Fax:
Practice Address - Street 1:30755-B AULD RD
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92591-7229
Practice Address - Country:US
Practice Address - Phone:951-696-3112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health