Provider Demographics
NPI:1467803429
Name:POLLOK, JACQUELINE (LPCC, LICDC)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:POLLOK
Suffix:
Gender:F
Credentials:LPCC, LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1170 OLD HENDERSON RD
Mailing Address - Street 2:SUITE 216
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-3623
Mailing Address - Country:US
Mailing Address - Phone:614-842-7999
Mailing Address - Fax:
Practice Address - Street 1:1170 OLD HENDERSON RD
Practice Address - Street 2:SUITE 216
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-3623
Practice Address - Country:US
Practice Address - Phone:614-842-7999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-30
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE1100168101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional