Provider Demographics
NPI:1184688103
Name:HOUSTON, JACQUELINE FRANCINE (LPC)
Entity type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:FRANCINE
Last Name:HOUSTON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5239 JESSUP RD
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23234-4639
Mailing Address - Country:US
Mailing Address - Phone:252-425-4117
Mailing Address - Fax:
Practice Address - Street 1:7410 HULL STREET RD STE 100
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-5834
Practice Address - Country:US
Practice Address - Phone:804-464-7363
Practice Address - Fax:804-251-1071
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-14
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701006208101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0701006208OtherVIRGINIA BOARD OF COUNSELING
NC6102567Medicaid