Provider Demographics
NPI:1922238054
Name:SWEEZER, JACQUELINE (LCSW)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:SWEEZER
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 1:998 HIGHWAY 1941
Mailing Address - Street 2:SUITE 1842
Mailing Address - City:HAMPTON
Mailing Address - State:GA
Mailing Address - Zip Code:30228
Mailing Address - Country:US
Mailing Address - Phone:800-973-8682
Mailing Address - Fax:800-973-8682
Practice Address - Street 1:998 HIGHWAY 1941
Practice Address - Street 2:SUITE 1842
Practice Address - City:HAMPTON
Practice Address - State:GA
Practice Address - Zip Code:30228
Practice Address - Country:US
Practice Address - Phone:800-973-8682
Practice Address - Fax:800-973-8682
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-23
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0028261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000900809BMedicaid
GA000900809AMedicaid
GA000900809BMedicaid