Provider Demographics
NPI:1265152722
Name:DEL VECCHIO, JESSICA DAVINE (LPC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:DAVINE
Last Name:DEL VECCHIO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 S CONGRESS AVE APT 624
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-1746
Mailing Address - Country:US
Mailing Address - Phone:505-697-7131
Mailing Address - Fax:
Practice Address - Street 1:116 18TH AVE S
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-4841
Practice Address - Country:US
Practice Address - Phone:801-895-4916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-02
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID9111101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health