Provider Demographics
NPI:1043526643
Name:FLEMING, JACQUELINE A (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:A
Last Name:FLEMING
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:574 SPRYFIELD RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39212-4645
Mailing Address - Country:US
Mailing Address - Phone:601-212-3454
Mailing Address - Fax:769-257-6295
Practice Address - Street 1:574 SPRYFIELD RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39212-4645
Practice Address - Country:US
Practice Address - Phone:601-212-3454
Practice Address - Fax:769-257-6295
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-20
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC03271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical