Provider Demographics
NPI:1558485045
Name:BAXLEY, JACQUELINE (MS, LPC, ACS)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:
Last Name:BAXLEY
Suffix:
Gender:F
Credentials:MS, LPC, ACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1139 E JERSEY ST STE 417
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07201-2446
Mailing Address - Country:US
Mailing Address - Phone:908-662-3200
Mailing Address - Fax:
Practice Address - Street 1:1139 E JERSEY ST STE 417
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07201-2446
Practice Address - Country:US
Practice Address - Phone:908-662-3200
Practice Address - Fax:908-662-3202
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health