Provider Demographics
NPI:1457526162
Name:STONE, JESSICA MARIE (CADCA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARIE
Last Name:STONE
Suffix:
Gender:F
Credentials:CADCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1314 OCEAN ST
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-2823
Mailing Address - Country:US
Mailing Address - Phone:831-423-9015
Mailing Address - Fax:831-423-9098
Practice Address - Street 1:1314 OCEAN ST
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-2823
Practice Address - Country:US
Practice Address - Phone:831-423-9015
Practice Address - Fax:831-423-9098
Is Sole Proprietor?:No
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB9085781OtherCA DL