Provider Demographics
NPI:1013308964
Name:WORTHINGTON, JACQUELINE RENEE (LCMHC)
Entity type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:RENEE
Last Name:WORTHINGTON
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 AQUA MARINE LN
Mailing Address - Street 2:
Mailing Address - City:KNIGHTDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27545-7869
Mailing Address - Country:US
Mailing Address - Phone:919-667-4583
Mailing Address - Fax:
Practice Address - Street 1:217 AQUA MARINE LN
Practice Address - Street 2:
Practice Address - City:KNIGHTDALE
Practice Address - State:NC
Practice Address - Zip Code:27545-7869
Practice Address - Country:US
Practice Address - Phone:919-667-4583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-13
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11219101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health