Provider Demographics
NPI:1801655139
Name:DAVISSON, JESSICA DEVA
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:DEVA
Last Name:DAVISSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 E ST STE 305
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-0351
Mailing Address - Country:US
Mailing Address - Phone:707-677-8200
Mailing Address - Fax:
Practice Address - Street 1:350 E ST STE 305
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-0351
Practice Address - Country:US
Practice Address - Phone:707-677-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA94028165103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling