Provider Demographics
NPI:1578029146
Name:DEPAOLI, JESSICA (LISW-CP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:DEPAOLI
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 TAHOE ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-6628
Mailing Address - Country:US
Mailing Address - Phone:513-519-5771
Mailing Address - Fax:
Practice Address - Street 1:2000 REYNOLDS AVE STE 201
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29405-5868
Practice Address - Country:US
Practice Address - Phone:513-519-5771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-19
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC15697101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health