Provider Demographics
NPI:1396161485
Name:VANHAMME, JESICA MARIE (MA ATR LLPC)
Entity type:Individual
Prefix:MRS
First Name:JESICA
Middle Name:MARIE
Last Name:VANHAMME
Suffix:
Gender:F
Credentials:MA ATR LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15265 PARIS ST
Mailing Address - Street 2:
Mailing Address - City:ALLEN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48101-3513
Mailing Address - Country:US
Mailing Address - Phone:313-409-0065
Mailing Address - Fax:
Practice Address - Street 1:15265 PARIS ST
Practice Address - Street 2:
Practice Address - City:ALLEN PARK
Practice Address - State:MI
Practice Address - Zip Code:48101-3513
Practice Address - Country:US
Practice Address - Phone:313-409-0065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-12
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401013552101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health