Provider Demographics
NPI:1689197725
Name:POLLARD, JACKIE L (LPCC-S, LSW, CDCA)
Entity Type:Individual
Prefix:MS
First Name:JACKIE
Middle Name:L
Last Name:POLLARD
Suffix:
Gender:F
Credentials:LPCC-S, LSW, CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6645 MARELIS AVE NE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44721-2470
Mailing Address - Country:US
Mailing Address - Phone:330-418-4665
Mailing Address - Fax:
Practice Address - Street 1:1867 W MARKET ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44313-6901
Practice Address - Country:US
Practice Address - Phone:330-926-5653
Practice Address - Fax:330-926-5653
Is Sole Proprietor?:No
Enumeration Date:2017-07-20
Last Update Date:2017-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS0002845104100000X
OHE0003339-SPV101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No104100000XBehavioral Health & Social Service ProvidersSocial Worker