Provider Demographics
NPI:1851624159
Name:PARRISH, JACQUELINE E (LCSW)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:E
Last Name:PARRISH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7370 IVEY HILL CIR
Mailing Address - Street 2:
Mailing Address - City:HAHIRA
Mailing Address - State:GA
Mailing Address - Zip Code:31632-2275
Mailing Address - Country:US
Mailing Address - Phone:229-794-1279
Mailing Address - Fax:
Practice Address - Street 1:23 MDG
Practice Address - Street 2:BEHAVIORAL HEALTH FLIGHT
Practice Address - City:MOODY A F B
Practice Address - State:GA
Practice Address - Zip Code:31699-0001
Practice Address - Country:US
Practice Address - Phone:229-257-3898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-17
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEQ1-00009761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical