Individual
JESSICA D HERSOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW, LADC
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
CAC5848
—
101YA0400X
Addiction (Substance Use Disorder) Counselor
LC6782
ME
104100000X
Social Worker
LM16932
—
1041C0700X
Clinical Social Worker
Primary
LC20114
ME
Other
Enumeration date
03/26/2018
Last updated
01/22/2026
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