Provider Demographics
NPI:1235504283
Name:GUESS, JIMMY I (MSW,ACSW,LCSW)
Entity Type:Individual
Prefix:
First Name:JIMMY
Middle Name:
Last Name:GUESS
Suffix:I
Gender:M
Credentials:MSW,ACSW,LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3818 NORTH ELM STREET ,SUITE E
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27455-2777
Mailing Address - Country:US
Mailing Address - Phone:336-508-2203
Mailing Address - Fax:336-545-5996
Practice Address - Street 1:3818 N ELM ST STE E
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27455-2778
Practice Address - Country:US
Practice Address - Phone:336-508-2203
Practice Address - Fax:336-545-5996
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-02
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC002421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical