Provider Demographics
NPI:1720588247
Name:VITELA, JESSICA PAOLA
Entity type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:PAOLA
Last Name:VITELA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1597 ESTEE AVE
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-2004
Mailing Address - Country:US
Mailing Address - Phone:707-287-0539
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 2024
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-0202
Practice Address - Country:US
Practice Address - Phone:707-287-0539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-21
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA150836101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health