Provider Demographics
NPI:1083785547
Name:FLEMING, JACQUELINE R (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:R
Last Name:FLEMING
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:JACQUELINE
Other - Middle Name:R
Other - Last Name:FLEMING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 246
Mailing Address - Street 2:
Mailing Address - City:PURCELLVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20134-0246
Mailing Address - Country:US
Mailing Address - Phone:540-338-8233
Mailing Address - Fax:540-338-7260
Practice Address - Street 1:170 W MAIN STREET
Practice Address - Street 2:201
Practice Address - City:PURCELLVILLE
Practice Address - State:VA
Practice Address - Zip Code:20132
Practice Address - Country:US
Practice Address - Phone:540-338-8233
Practice Address - Fax:540-338-7260
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040020211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical