Provider Demographics
NPI:1659654937
Name:SAPPAH, JACLYN MAY (LCSW)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:MAY
Last Name:SAPPAH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 BENDEMEER LN
Mailing Address - Street 2:
Mailing Address - City:ROLESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27571-9751
Mailing Address - Country:US
Mailing Address - Phone:919-524-3390
Mailing Address - Fax:
Practice Address - Street 1:515 BENDEMEER LN
Practice Address - Street 2:
Practice Address - City:ROLESVILLE
Practice Address - State:NC
Practice Address - Zip Code:27571-9751
Practice Address - Country:US
Practice Address - Phone:919-524-3390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-23
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0124201041C0700X
NY0875601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical