Provider Demographics
NPI:1841052149
Name:DRAKE, JESSICA L (MHCAMC61514280)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:DRAKE
Suffix:
Gender:F
Credentials:MHCAMC61514280
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7716 RIXIE ST SE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-5666
Mailing Address - Country:US
Mailing Address - Phone:360-480-9335
Mailing Address - Fax:
Practice Address - Street 1:7716 RIXIE ST SE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-5666
Practice Address - Country:US
Practice Address - Phone:360-480-9335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMHCA.MC.61514280101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health