Provider Demographics
NPI:1891033809
Name:MACDONALD, JESSICA MICHELLE (BA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:MICHELLE
Last Name:MACDONALD
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:542 OCEAN ST
Mailing Address - Street 2:SUITE K
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-6622
Mailing Address - Country:US
Mailing Address - Phone:831-459-0444
Mailing Address - Fax:831-459-0665
Practice Address - Street 1:542 OCEAN ST
Practice Address - Street 2:SUIT K
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-6622
Practice Address - Country:US
Practice Address - Phone:831-459-0444
Practice Address - Fax:831-459-0665
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-25
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health