Provider Demographics
NPI:1720206360
Name:SABATH, JACQUELINE ANNE (LCPC)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:ANNE
Last Name:SABATH
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 JUBILEE LN
Mailing Address - Street 2:
Mailing Address - City:HARPERS FERRY
Mailing Address - State:WV
Mailing Address - Zip Code:25425-6554
Mailing Address - Country:US
Mailing Address - Phone:304-724-6653
Mailing Address - Fax:
Practice Address - Street 1:4413 TUCKERMAN ST
Practice Address - Street 2:UNIVERSITY CHURCH OF THE BRETHREN
Practice Address - City:UNIVERSITY PARK
Practice Address - State:MD
Practice Address - Zip Code:20782-2148
Practice Address - Country:US
Practice Address - Phone:304-261-2653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC1200101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral