Provider Demographics
NPI:1699005710
Name:TRUITT, JACQUELINE PHILLIPS (MA LPC)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:PHILLIPS
Last Name:TRUITT
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7550 HORIZON LINE DR
Mailing Address - Street 2:APARTMENT 9101
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27617-8698
Mailing Address - Country:US
Mailing Address - Phone:919-824-9069
Mailing Address - Fax:
Practice Address - Street 1:7550 HORIZON LINE DR
Practice Address - Street 2:APARTMENT 9101
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27617-8698
Practice Address - Country:US
Practice Address - Phone:919-824-9069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-12
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7726101Y00000X, 101YM0800X, 101YP2500X, 101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool