Provider Demographics
NPI:1972014843
Name:ENGLISH, JACKQUELINA (SUPERVISED THERAPIST)
Entity Type:Individual
Prefix:
First Name:JACKQUELINA
Middle Name:
Last Name:ENGLISH
Suffix:
Gender:F
Credentials:SUPERVISED THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 NUNNALLY DR
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-7985
Mailing Address - Country:US
Mailing Address - Phone:404-360-0069
Mailing Address - Fax:
Practice Address - Street 1:313 NUNNALLY DR
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7985
Practice Address - Country:US
Practice Address - Phone:404-360-0069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-19
Last Update Date:2017-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor