Provider Demographics
NPI:1447614789
Name:WAYNE, JACQUELINE BELHUMEUR (MA, LPA)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:BELHUMEUR
Last Name:WAYNE
Suffix:
Gender:F
Credentials:MA, LPA
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:RENEE
Other - Last Name:BELHUMEUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LPA
Mailing Address - Street 1:1064 MEADOWVIEW DR
Mailing Address - Street 2:STE 4
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-4821
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1064 MEADOWVIEW DR
Practice Address - Street 2:STE 4
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-4821
Practice Address - Country:US
Practice Address - Phone:804-475-5503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-13
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4957103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical