Provider Demographics
NPI:1154742294
Name:JAMIE EVERSOLE, LISW, LLC
Entity type:Organization
Organization Name:JAMIE EVERSOLE, LISW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED INDEPENDENT SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:EVERSOLE
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:419-654-6699
Mailing Address - Street 1:698 MORRISON RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-4419
Mailing Address - Country:US
Mailing Address - Phone:419-654-6699
Mailing Address - Fax:614-626-8805
Practice Address - Street 1:698 MORRISON RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-4419
Practice Address - Country:US
Practice Address - Phone:419-654-6699
Practice Address - Fax:614-626-8805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-16
Last Update Date:2013-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI. 1303306251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health