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Individual
JESSE N SPAIN
Active
Individual
JESSE N SPAIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CADC II/QMHA-I
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
15-01-09
OR
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
17-04-13
OR
101YM0800X
Mental Health Counselor
19-QMHA-I-00297
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500700056
—
OR
05
—
500722603
—
OR
Enumeration date
02/04/2016
Last updated
07/11/2019
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