Provider Demographics
NPI:1780910133
Name:DINEEN, JESSICA RAE (MS)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:RAE
Last Name:DINEEN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:RAE
Other - Last Name:MULLICAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APCC
Mailing Address - Street 1:27711 NIGUEL VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-4017
Mailing Address - Country:US
Mailing Address - Phone:949-280-1994
Mailing Address - Fax:
Practice Address - Street 1:11835 W OLYMPIC BLVD STE 815E
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-5056
Practice Address - Country:US
Practice Address - Phone:323-332-9905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-20
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
CA12451101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor