Provider Demographics
NPI:1891845343
Name:STRONG, JACQUELINE (LISW CP)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:
Last Name:STRONG
Suffix:
Gender:F
Credentials:LISW CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2461 MILL CREEK RD
Mailing Address - Street 2:
Mailing Address - City:BETHUNE
Mailing Address - State:SC
Mailing Address - Zip Code:29009-9078
Mailing Address - Country:US
Mailing Address - Phone:843-334-6207
Mailing Address - Fax:
Practice Address - Street 1:246 W CALHOUN ST
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-4243
Practice Address - Country:US
Practice Address - Phone:803-775-2801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC83721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical