Provider Demographics
NPI:1881822799
Name:DE JESUS, CHRISTINE (MS, EDS)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:DE JESUS
Suffix:
Gender:F
Credentials:MS, EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 MINDANAO DR APT 507
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-8874
Mailing Address - Country:US
Mailing Address - Phone:904-525-6373
Mailing Address - Fax:
Practice Address - Street 1:10175 FORTUNE PKWY
Practice Address - Street 2:SUITE 1102
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-6746
Practice Address - Country:US
Practice Address - Phone:904-525-6373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-30
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health