Provider Demographics
NPI:1679186464
Name:OVERSTREET, JACQUELYN ALISHA
Entity Type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:ALISHA
Last Name:OVERSTREET
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6451 FREDA DR
Mailing Address - Street 2:
Mailing Address - City:PINSON
Mailing Address - State:AL
Mailing Address - Zip Code:35126-3115
Mailing Address - Country:US
Mailing Address - Phone:205-427-7010
Mailing Address - Fax:
Practice Address - Street 1:100 CENTERVIEW DR STE 201
Practice Address - Street 2:
Practice Address - City:VESTAVIA HILLS
Practice Address - State:AL
Practice Address - Zip Code:35216-3747
Practice Address - Country:US
Practice Address - Phone:205-807-5372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-31
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical