Provider Demographics
NPI:1598457756
Name:JEAN-MARIE, DEVIN A
Entity Type:Individual
Prefix:
First Name:DEVIN
Middle Name:A
Last Name:JEAN-MARIE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:441 N FLOWER ST APT 4
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-1456
Mailing Address - Country:US
Mailing Address - Phone:907-351-2352
Mailing Address - Fax:
Practice Address - Street 1:4600 DEBARR RD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-3103
Practice Address - Country:US
Practice Address - Phone:907-764-3324
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health