Provider Demographics
NPI:1245858661
Name:QUALLS, JESSICA R (LCSW)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:R
Last Name:QUALLS
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 E JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32501-4337
Mailing Address - Country:US
Mailing Address - Phone:850-619-0973
Mailing Address - Fax:
Practice Address - Street 1:1500 E JACKSON ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501-4337
Practice Address - Country:US
Practice Address - Phone:850-619-0973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-13
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW17401104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker