Provider Demographics
NPI:1275994097
Name:GARRETT, JAQUITA
Entity Type:Individual
Prefix:
First Name:JAQUITA
Middle Name:
Last Name:GARRETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2002 JAY ST
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70460-6648
Mailing Address - Country:US
Mailing Address - Phone:757-575-3517
Mailing Address - Fax:
Practice Address - Street 1:19411 HELENBIRG RD STE 102
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-5199
Practice Address - Country:US
Practice Address - Phone:985-888-1794
Practice Address - Fax:985-888-1795
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-08
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor