Provider Demographics
NPI:1104440502
Name:ALDERSON, JESSICA A (RADT)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:A
Last Name:ALDERSON
Suffix:
Gender:F
Credentials:RADT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 3RD ST STE 106
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:CA
Mailing Address - Zip Code:95648-2500
Mailing Address - Country:US
Mailing Address - Phone:530-434-8927
Mailing Address - Fax:
Practice Address - Street 1:1530 3RD ST STE 106
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:CA
Practice Address - Zip Code:95648-2500
Practice Address - Country:US
Practice Address - Phone:530-434-8927
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-01
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1379280320101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)