Provider Demographics
NPI:1497488050
Name:GHOLAMI, JESSI (LCSW-C)
Entity type:Individual
Prefix:
First Name:JESSI
Middle Name:
Last Name:GHOLAMI
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1916 CHRISTIANA CT
Mailing Address - Street 2:
Mailing Address - City:SEVERN
Mailing Address - State:MD
Mailing Address - Zip Code:21144-1484
Mailing Address - Country:US
Mailing Address - Phone:248-807-5734
Mailing Address - Fax:
Practice Address - Street 1:3005 BOARDWALK ST STE 201
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-5218
Practice Address - Country:US
Practice Address - Phone:734-222-9277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-01
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011140621041C0700X
MD300921041C0700X
DCC2000040221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical