Individual
DR. JADE STAR FEWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSY.D.ASSISTANT
Contact information
Practice address
3151 AIRWAY AVE STE J2, COSTA MESA, CA 92626-4624
(949) 702-4677
Mailing address
PO BOX 1946, LAGUNA BEACH, CA 92652-1946
(949) 702-4677
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
15155
CA
103T00000X
Psychologist
Primary
94026429
CA
Other
Enumeration date
10/20/2021
Last updated
12/26/2021
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