Provider Demographics
NPI:1013129956
Name:O'CONNELL, JACQUELINE LUANN (PHD)
Entity type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:LUANN
Last Name:O'CONNELL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:JACQUELINE
Other - Middle Name:LUANN
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:8910 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-4916
Mailing Address - Country:US
Mailing Address - Phone:770-924-1818
Mailing Address - Fax:770-928-5731
Practice Address - Street 1:8910 MAIN ST
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-4916
Practice Address - Country:US
Practice Address - Phone:770-924-1818
Practice Address - Fax:770-928-5731
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY003915103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist