Provider Demographics
NPI:1174832653
Name:HAFFORD, JACQUELYN A (LCSW-S)
Entity Type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:A
Last Name:HAFFORD
Suffix:
Gender:F
Credentials:LCSW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 MCMACKIN ST
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-6886
Mailing Address - Country:US
Mailing Address - Phone:817-383-9157
Mailing Address - Fax:817-761-5364
Practice Address - Street 1:610 UPTOWN BLVD STE 2000
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-3528
Practice Address - Country:US
Practice Address - Phone:817-383-9157
Practice Address - Fax:817-761-5364
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-30
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX389821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical