Provider Demographics
NPI:1144532581
Name:JEPPSON, ALECIA RAE (LCSW)
Entity type:Individual
Prefix:
First Name:ALECIA
Middle Name:RAE
Last Name:JEPPSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ALECIA
Other - Middle Name:MOWER
Other - Last Name:JEPPSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:4464 LONE TREE WAY # 1069
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94531-7413
Mailing Address - Country:US
Mailing Address - Phone:209-820-1500
Mailing Address - Fax:
Practice Address - Street 1:730 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-4104
Practice Address - Country:US
Practice Address - Phone:209-820-1500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-13
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 264801041C0700X
UT592423735011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical