Provider Demographics
NPI:1437606357
Name:BACK, TAMAR JESSICA (LCSWA)
Entity Type:Individual
Prefix:
First Name:TAMAR
Middle Name:JESSICA
Last Name:BACK
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 VANCE CRESCENT ST
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28806-3011
Mailing Address - Country:US
Mailing Address - Phone:201-390-4714
Mailing Address - Fax:
Practice Address - Street 1:19 ZILLICOA ST # 3
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-1063
Practice Address - Country:US
Practice Address - Phone:828-333-4907
Practice Address - Fax:828-412-3257
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-08
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0185831041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical