Provider Demographics
NPI:1689303414
Name:LOHF, JESSICA NICOLE (R1470960622)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:NICOLE
Last Name:LOHF
Suffix:
Gender:F
Credentials:R1470960622
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 HARBISON DR
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-3930
Mailing Address - Country:US
Mailing Address - Phone:916-767-7576
Mailing Address - Fax:
Practice Address - Street 1:3501 HARBISON DR
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-3930
Practice Address - Country:US
Practice Address - Phone:916-767-7576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-07
Last Update Date:2023-09-22
Deactivation Date:2023-08-10
Deactivation Code:
Reactivation Date:2023-08-23
Provider Licenses
StateLicense IDTaxonomies
CAASW116095390200000X
CAR1470960622101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program