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General NPI Number Information
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NPI Number | 1811777840
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Entity Type | Individual
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Provider Name | JESSICA GABRIELA ANDRADE APCC
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Gender | Female
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Dates
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Enumeration Date | 10/05/2023
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Last Update Date | 10/05/2023
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Provider Practice Location Address
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Address Line | 1777 S 11TH ST
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City | LOS BANOS
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State | CA
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Zip | 93635-4800
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Country | US
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Telephone | 209-675-2226
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Fax |
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Provider Business Mailing Address
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Address Line | 970 SOLARI AVE
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City | STOCKTON
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State | CA
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Zip | 95205-4245
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Country | US
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Telephone | 209-938-8778
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | APCC31371
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License Number State | CA
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