Provider Demographics
NPI:1629692496
Name:CASKEY-JAMES, JACQUELINE LEE
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:LEE
Last Name:CASKEY-JAMES
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:JACQUELINE
Other - Middle Name:LEE
Other - Last Name:CASKEY-JAMES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, LPC, NCC, CPCS
Mailing Address - Street 1:106 N MILLER ST
Mailing Address - Street 2:
Mailing Address - City:FORT VALLEY
Mailing Address - State:GA
Mailing Address - Zip Code:31030-4245
Mailing Address - Country:US
Mailing Address - Phone:404-486-3699
Mailing Address - Fax:478-825-6058
Practice Address - Street 1:106 N MILLER ST
Practice Address - Street 2:
Practice Address - City:FORT VALLEY
Practice Address - State:GA
Practice Address - Zip Code:31030-4245
Practice Address - Country:US
Practice Address - Phone:404-486-3699
Practice Address - Fax:478-825-6058
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-08
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005534101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional