Provider Demographics
NPI:1679859292
Name:ADAIR, JACQUELINE JADE (LCSW, LCDC)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:JADE
Last Name:ADAIR
Suffix:
Gender:F
Credentials:LCSW, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9201 BRODIE LN
Mailing Address - Street 2:UNIT 1703
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78748-5991
Mailing Address - Country:US
Mailing Address - Phone:512-689-7491
Mailing Address - Fax:
Practice Address - Street 1:8700 MENCHACA RD STE 306
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78748-5374
Practice Address - Country:US
Practice Address - Phone:512-766-6013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-27
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11996101YA0400X
TX557491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)