Provider Demographics
NPI:1003586595
Name:DEMUS, JAQUAVIA LYNN (LBSW, LCDC, LPC)
Entity type:Individual
Prefix:
First Name:JAQUAVIA
Middle Name:LYNN
Last Name:DEMUS
Suffix:
Gender:F
Credentials:LBSW, LCDC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1928 ACKLEN RUN DR
Mailing Address - Street 2:
Mailing Address - City:ROSHARON
Mailing Address - State:TX
Mailing Address - Zip Code:77583-2901
Mailing Address - Country:US
Mailing Address - Phone:346-775-1129
Mailing Address - Fax:
Practice Address - Street 1:1928 ACKLEN RUN DR
Practice Address - Street 2:
Practice Address - City:ROSHARON
Practice Address - State:TX
Practice Address - Zip Code:77583-2901
Practice Address - Country:US
Practice Address - Phone:346-775-1129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-15
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61809104100000X
TX91346101YM0800X
TX15954101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)