Provider Demographics
NPI:1669130886
Name:DE JULIO, JESSICA NICOLE (CADC III)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:NICOLE
Last Name:DE JULIO
Suffix:
Gender:F
Credentials:CADC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:768 GRIFFEY WAY
Mailing Address - Street 2:
Mailing Address - City:GALT
Mailing Address - State:CA
Mailing Address - Zip Code:95632-3065
Mailing Address - Country:US
Mailing Address - Phone:916-612-2452
Mailing Address - Fax:209-744-9909
Practice Address - Street 1:750 SPAANS DR STE F
Practice Address - Street 2:
Practice Address - City:GALT
Practice Address - State:CA
Practice Address - Zip Code:95632-8609
Practice Address - Country:US
Practice Address - Phone:209-744-9909
Practice Address - Fax:209-744-9910
Is Sole Proprietor?:No
Enumeration Date:2021-12-05
Last Update Date:2021-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB00002231121101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)