JESSICA KOSTELIC (NPI# 1194260877) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1194260877 |
| Entity Type | Individual |
| Full Name | JESSICA KOSTELIC |
| Practice Address |
1466 Lincoln Ave San Rafael CA 94901-2021 |
| Practice Telephone | 4154573755 |
| Mailing Telephone | 4154573755 |
| Enumeration Date | 2017-01-04 |
| Last Update Date | 2017-01-04 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
9826-R | CA | Behavioral Health & Social Service Providers |
| Street Address |
1466 LINCOLN AVE |
| City | SAN RAFAEL |
| State | CA |
| Zip Code | 94901-2021 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265522528 | Russell Leonard Sandberg | Internal Medicine | 1466 Lincoln Ave, San Rafael, CA 94901-2021 | 2006-10-14 |
| 1811523046 | Gabriela Liliana Lara | Counselor | 1466 Lincoln Ave, San Rafael, CA 94901-2021 | 2020-03-19 |
| 1649805300 | Alexis Soria | Counselor | 1466 Lincoln Ave, San Rafael, CA 94901-2021 | 2020-03-03 |
| 1821640913 | Rajena Laffey | Counselor | 1466 Lincoln Ave, San Rafael, CA 94901-2021 | 2019-07-10 |
| 1932688033 | Jonathan Alexander Cantu | Counselor | 1466 Lincoln Ave, San Rafael, CA 94901-2021 | 2018-08-09 |
| 1568966737 | Christina Marie Chavez | Licensed Vocational Nurse | 1466 Lincoln Ave, San Rafael, CA 94901-2021 | 2018-03-21 |
| 1679000442 | Edelyn Panaligan | Licensed Vocational Nurse | 1466 Lincoln Ave, San Rafael, CA 94901-2021 | 2017-05-11 |
| 1023559028 | Lavenia Brown | Counselor | 1466 Lincoln Ave, San Rafael, CA 94901-2021 | 2017-03-10 |
| 1255877577 | Sharon Forsythe | Counselor | 1466 Lincoln Ave, San Rafael, CA 94901-2021 | 2017-01-10 |
| 1639627144 | Linna Kong | Marriage & Family Therapist | 1466 Lincoln Ave, San Rafael, CA 94901-2021 | 2016-09-13 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780207134 | Marianne Haissman Stefancic | Marriage & Family Therapist | 409 Forbes Ave., San Rafael, CA 94901 | 2020-05-20 |
| 1093292765 | Marin Community Clinic | Clinic/Center | 411 4th Strteet, Suite A, San Rafael, CA 94901 | 2018-07-25 |
| 1275052516 | Laura Ellen Silverstein | Marriage & Family Therapist | 600 Fifth Avenue, San Rafael, CA 94901 | 2017-09-19 |
| 1689101107 | Marin Family Recovery | Clinic/Center | 1209 Third St. Ste 4, San Rafael, CA 94901 | 2017-05-15 |
| 1376070011 | Tencia Beavers-sanchez | Counselor | 710 C Street Suite#8, Marin Outpatient&recoveryservices, Sanrafael, CA 94901 | 2017-05-12 |
| 1326584905 | Jamie Waterman | Emergency Medical Technician, Basic | 675 Sir Francis Drake Blvd, Kentfield, CA 94901 | 2017-01-06 |
| 1295270676 | Stephen Marks | Counselor | 900 Fifth Avenue, Suite 150, ; San Rafael, CA 94901 | 2016-12-21 |
| 1497299812 | Vesna Sturman | Psychologist | 712 D St Ste L, San Rafael, CA 94901 | 2016-12-05 |
| 1063955771 | Carol Dutton Hollenberg | Behavior Technician | 503 D St., San Rafael, CA 94901 | 2016-11-29 |
| 1083069447 | Bay Area Community Resources | Community/Behavioral Health | 103 Shoreline Parkway, San Rafael, CA 94901 | 2016-05-04 |
| Find all providers in zip 94901 | ||||
| Taxonomy Code | 101YA0400X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Addiction (Substance Use Disorder) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912542457 | Stephen Lochrane Prince | Counselor | 10 N San Pedro Rd Ste 1015, San Rafael, CA 94903-4155 | 2019-11-07 |
| 1912463332 | Jenna Roth Ring | Counselor | 1005 Northgate Dr # 115, San Rafael, CA 94903-2500 | 2019-02-11 |
| 1194263228 | Daron Austin | Counselor | 710 C St Ste 8, San Rafael, CA 94901-3853 | 2017-02-09 |
| 1427507789 | Full Circle Addiction and Recovery Services | Counselor | 1104 Lincoln Ave, San Rafael, CA 94901-3245 | 2016-09-28 |
| 1750744637 | Karen Witt | Counselor | 110 Plymouth Cv, San Rafael, CA 94901-4461 | 2016-03-30 |
| 1952763724 | Donald Lee Merriam IIi | Counselor | 603 D Street, San Rafael, CA 94901 | 2016-03-22 |
| 1912367236 | Felipe Perez | Counselor | 710 C Street, Suite 7, San Rafael, CA 94901 | 2016-02-29 |
| 1568839926 | Jenna Kerler | Counselor | 22 San Pablo Ave Apt 2, San Rafael, CA 94903-4122 | 2015-09-01 |
| 1598159790 | James Paul Goss IIi | Counselor | 1005 A St Ste 209, San Rafael, CA 94901-3127 | 2015-03-25 |
| 1053702787 | Marin Outpatient Recovery Services | Counselor | 11 Albion St, San Rafael, CA 94901-5201 | 2015-02-17 |
| Find all providers in SAN RAFAEL | ||||
| City | SAN RAFAEL |
| Zip Code | 94901 |
Please comment or provide details below to improve the information on JESSICA KOSTELIC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.