Provider Demographics
NPI:1922863786
Name:QUAM, JESSE (LCSW)
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:
Last Name:QUAM
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 BLACK MOUNTAIN AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:BLACK MOUNTAIN
Mailing Address - State:NC
Mailing Address - Zip Code:28711-3402
Mailing Address - Country:US
Mailing Address - Phone:828-423-6469
Mailing Address - Fax:
Practice Address - Street 1:103 BLACK MOUNTAIN AVE STE 4
Practice Address - Street 2:
Practice Address - City:BLACK MOUNTAIN
Practice Address - State:NC
Practice Address - Zip Code:28711-3402
Practice Address - Country:US
Practice Address - Phone:828-423-6469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-20
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC005917101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health