Clarissa Rosalee Jolly, TCADC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

23055 Issued in IA

Practice address

3640 Canterbury CT
Waterloo, IA 50702-5705

Phone

(319) 252-4631

Fax

(319) 209-9287

NPI assigned

Jul 10, 2023

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1688947200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688947200000",
    "number": "1073291902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3640 CANTERBURY CT",
            "city": "WATERLOO",
            "state": "IA",
            "postal_code": "507025705",
            "telephone_number": "319-252-4631",
            "fax_number": "319-209-9287"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3640 CANTERBURY CT",
            "city": "WATERLOO",
            "state": "IA",
            "postal_code": "507025705",
            "telephone_number": "319-252-4631",
            "fax_number": "319-209-9287"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOLLY",
        "first_name": "CLARISSA",
        "middle_name": "ROSALEE",
        "credential": "TCADC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-07-10",
        "last_updated": "2023-07-10",
        "certification_date": "2023-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "IA",
            "license": "23055",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ryan Scott Johnson, RNFA
• Stefani Johnson
• Hope Johnston, DC
• Andrew L Jolley, D.C.
• Darcy Evelyn Jolley, LMSW
• Emalie Diane Jones
• Darrian Deangelis Jordan
• Connie Joylani, MD
• Kevin Eliot Juro, MD
• Merisa Jusic, MD

• Addiction (Substance Use Disorder) Counselor in Waterloo, IA
• Providers in Waterloo, IA by specialty
• Addiction (Substance Use Disorder) Counselor in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.