Provider Demographics
NPI:1154720555
Name:DIEPPA, JESSICA B (LMHC, MCAP, NCC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:B
Last Name:DIEPPA
Suffix:
Gender:F
Credentials:LMHC, MCAP, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15000 SW 149TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-4416
Mailing Address - Country:US
Mailing Address - Phone:305-989-0493
Mailing Address - Fax:
Practice Address - Street 1:13550 N KENDALL DR STE 270C
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-1513
Practice Address - Country:US
Practice Address - Phone:305-989-0493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-21
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMCAP100498101YA0400X
FLMH15433101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL022974600Medicaid