Provider Demographics
NPI:1861773715
Name:NOVOA, JESSICA LYNN (ASW)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:LYNN
Last Name:NOVOA
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:MISS
Other - First Name:JESSICA
Other - Middle Name:LYNN
Other - Last Name:CARPENTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1666 N MAIN ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701-7417
Mailing Address - Country:US
Mailing Address - Phone:714-704-5900
Mailing Address - Fax:714-978-3419
Practice Address - Street 1:1666 N MAIN ST
Practice Address - Street 2:SUITE 400
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-7417
Practice Address - Country:US
Practice Address - Phone:714-704-5900
Practice Address - Fax:714-978-3419
Is Sole Proprietor?:No
Enumeration Date:2011-09-06
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW36270101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health