Provider Demographics
NPI:1922056522
Name:FRANCIS, JACQUELINE RUTH (PHD)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:RUTH
Last Name:FRANCIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 N. MAGNOLIA ST.
Mailing Address - Street 2:SWCMHC,
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29151-1946
Mailing Address - Country:US
Mailing Address - Phone:803-775-9364
Mailing Address - Fax:803-773-6615
Practice Address - Street 1:, 215 N. MAGNOLIA ST.
Practice Address - Street 2:SWCMHC
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29151-1946
Practice Address - Country:US
Practice Address - Phone:803-775-9364
Practice Address - Fax:803-773-6615
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC587103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQ32866Medicare UPIN