Provider Demographics
NPI:1215781075
Name:CHAVEZ, JESSICA K (SUDRC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:K
Last Name:CHAVEZ
Suffix:
Gender:F
Credentials:SUDRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 E ALISAL ST
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-3519
Mailing Address - Country:US
Mailing Address - Phone:831-229-2929
Mailing Address - Fax:831-759-2269
Practice Address - Street 1:128 E ALISAL ST
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-3519
Practice Address - Country:US
Practice Address - Phone:831-229-2929
Practice Address - Fax:831-759-2269
Is Sole Proprietor?:No
Enumeration Date:2024-04-16
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12767101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)