Provider Demographics
NPI:1689059875
Name:HUSBAND, JAMIE (LCSWA)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:
Last Name:HUSBAND
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:
Other - Last Name:FAIRLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1321
Mailing Address - Street 2:
Mailing Address - City:BEULAVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28518-1321
Mailing Address - Country:US
Mailing Address - Phone:910-298-6207
Mailing Address - Fax:910-298-6293
Practice Address - Street 1:191 NORTH NC HWY 41
Practice Address - Street 2:
Practice Address - City:BEULAVILLE
Practice Address - State:NC
Practice Address - Zip Code:28518
Practice Address - Country:US
Practice Address - Phone:910-298-6207
Practice Address - Fax:910-298-6293
Is Sole Proprietor?:No
Enumeration Date:2015-07-29
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0098331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical