Provider Demographics
NPI:1932363769
Name:CLINTON-HELMS, JOLENE MARIE (LADC)
Entity Type:Individual
Prefix:MS
First Name:JOLENE
Middle Name:MARIE
Last Name:CLINTON-HELMS
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 PORTOLA DR # 7
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-5101
Mailing Address - Country:US
Mailing Address - Phone:831-419-3161
Mailing Address - Fax:
Practice Address - Street 1:3100 PORTOLA DR # 7
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062-5101
Practice Address - Country:US
Practice Address - Phone:831-419-3161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-10
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK505101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)