Provider Demographics
NPI:1134518871
Name:LOVE-BELLE, JESSIE DOLORES (MASTERS LEVEL CAP)
Entity type:Individual
Prefix:MRS
First Name:JESSIE
Middle Name:DOLORES
Last Name:LOVE-BELLE
Suffix:
Gender:F
Credentials:MASTERS LEVEL CAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 WHEATFIELD DR
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-3927
Mailing Address - Country:US
Mailing Address - Phone:386-569-4748
Mailing Address - Fax:386-313-1955
Practice Address - Street 1:4750 E MOODY BLVD
Practice Address - Street 2:
Practice Address - City:BUNNELL
Practice Address - State:FL
Practice Address - Zip Code:32110-7709
Practice Address - Country:US
Practice Address - Phone:386-569-4748
Practice Address - Fax:386-313-1955
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-19
Last Update Date:2015-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0718AD141801101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)