Provider Demographics
NPI:1811777840
Name:ANDRADE, JESSICA GABRIELA (APCC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:GABRIELA
Last Name:ANDRADE
Suffix:
Gender:F
Credentials:APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:970 SOLARI AVE
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95205-4245
Mailing Address - Country:US
Mailing Address - Phone:209-938-8778
Mailing Address - Fax:
Practice Address - Street 1:1777 S 11TH ST
Practice Address - Street 2:
Practice Address - City:LOS BANOS
Practice Address - State:CA
Practice Address - Zip Code:93635-4800
Practice Address - Country:US
Practice Address - Phone:209-675-2226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-05
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAPCC31371101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional