Healthcare Provider Details

I. General information

NPI: 1265306922
Provider Name (Legal Business Name): JACQUELINE N PUTNAM LCSWA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2025
Last Update Date: 10/13/2025
Certification Date: 10/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 FAIRVIEW RD OFFICE #4, SUITE 4000
ASHEVILLE NC
28803-1171
US

IV. Provider business mailing address

802 FAIRVIEW RD OFFICE #4, SUITE #4000
ASHEVILLE NC
28803-1171
US

V. Phone/Fax

Practice location:
  • Phone: 828-367-7719
  • Fax: 828-820-5503
Mailing address:
  • Phone: 828-367-7719
  • Fax: 828-820-5503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP022741
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: