Provider Demographics
NPI:1497360770
Name:STERLING-RANSOM, JAQUETTE EBONY (LPC)
Entity Type:Individual
Prefix:
First Name:JAQUETTE
Middle Name:EBONY
Last Name:STERLING-RANSOM
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 SPRUCE HILL DR
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62221-3602
Mailing Address - Country:US
Mailing Address - Phone:618-616-9309
Mailing Address - Fax:
Practice Address - Street 1:1725 SPRUCE HILL DR
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62221-3602
Practice Address - Country:US
Practice Address - Phone:618-616-9309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-13
Last Update Date:2020-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178014515101YP2500X
MO2019023835101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional