Provider Demographics
NPI:1245270768
Name:MANWARING, JACQUELINE YVONNE (RSW,MA,LPC,LMFT,NCC)
Entity type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:YVONNE
Last Name:MANWARING
Suffix:
Gender:F
Credentials:RSW,MA,LPC,LMFT,NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620 CENTENARY BLVD
Mailing Address - Street 2:SUITE306
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71104-3356
Mailing Address - Country:US
Mailing Address - Phone:318-676-3332
Mailing Address - Fax:318-676-3335
Practice Address - Street 1:2620 CENTENARY BLVD
Practice Address - Street 2:SUITE306
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71104-3356
Practice Address - Country:US
Practice Address - Phone:318-676-3332
Practice Address - Fax:318-676-3335
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD88025101Y00000X
LA2913101YP2500X
LA6633104100000X
LA857106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist