Provider Demographics
NPI:1871726406
Name:QUESINBERRY, JIMMIE GREEN JR (LPC)
Entity type:Individual
Prefix:MR
First Name:JIMMIE
Middle Name:GREEN
Last Name:QUESINBERRY
Suffix:JR
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 HAMILTONS CROSS RD
Mailing Address - Street 2:
Mailing Address - City:MARSHVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28103-9091
Mailing Address - Country:US
Mailing Address - Phone:704-624-2584
Mailing Address - Fax:
Practice Address - Street 1:328 W CARSON BLVD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-4024
Practice Address - Country:US
Practice Address - Phone:704-375-9025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-31
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7442101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional