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Individual
JESSICA L SPAIN
Active
Individual
JESSICA L SPAIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CADC I/QMHA-R
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
20-03-16U
OR
101YM0800X
Mental Health Counselor
19-QMHA-R-0061
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500738245
—
OR
05
—
500774907
—
OR
Enumeration date
07/19/2017
Last updated
01/06/2021
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