Provider Demographics
NPI:1902272990
Name:VENCILL-OPP, JESSYCA (MA, MHP, LMHC, SUDP)
Entity Type:Individual
Prefix:
First Name:JESSYCA
Middle Name:
Last Name:VENCILL-OPP
Suffix:
Gender:F
Credentials:MA, MHP, LMHC, SUDP
Other - Prefix:
Other - First Name:JESSYCA
Other - Middle Name:NECHELLE
Other - Last Name:OPP-SOBANIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, MHP, SUDP, LMHC
Mailing Address - Street 1:4514 TOUTLE CT SE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-9573
Mailing Address - Country:US
Mailing Address - Phone:360-584-4106
Mailing Address - Fax:
Practice Address - Street 1:4514 TOUTLE CT SE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-9573
Practice Address - Country:US
Practice Address - Phone:360-584-4106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-13
Last Update Date:2021-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60943211101YA0400X
WAMC6081310101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)