Healthcare Provider Details

I. General information

NPI: 1134398654
Provider Name (Legal Business Name): JESSICA ANGELINE BELCHER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2008
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

670 PLACERVILLE DR
PLACERVILLE CA
95667-4200
US

IV. Provider business mailing address

670 PLACERVILLE DR
PLACERVILLE CA
95667-4200
US

V. Phone/Fax

Practice location:
  • Phone: 530-295-1657
  • Fax:
Mailing address:
  • Phone: 530-344-4843
  • Fax: 530-622-5800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number063970324
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: