Provider Demographics
NPI:1891515987
Name:WALL, JAMESON HORNBECK (LCSWA)
Entity type:Individual
Prefix:
First Name:JAMESON
Middle Name:HORNBECK
Last Name:WALL
Suffix:
Gender:M
Credentials:LCSWA
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:
Other - Last Name:WALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:19 ZILLICOA ST STE 3
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-1063
Mailing Address - Country:US
Mailing Address - Phone:828-333-4907
Mailing Address - Fax:828-412-3257
Practice Address - Street 1:19 ZILLICOA ST STE 3
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-1063
Practice Address - Country:US
Practice Address - Phone:828-333-4907
Practice Address - Fax:828-412-3257
Is Sole Proprietor?:No
Enumeration Date:2024-10-14
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0213481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical