Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | ||
Y | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | PSB94021710 | CA |
NPI | 1225297609 |
---|---|
Provider Name | Dr. Jessica Leigh Thivierge |
First Address | San Diego, CA 92101-3291 |
Second Address | San Diego, CA 92101-3291 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2008 |
Last Update Date | 26/02/2016 |