Provider Demographics
NPI:1265608871
Name:ST CLAIR, JACQUELINE LEIGH BOWEN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:LEIGH BOWEN
Last Name:ST CLAIR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:LEIGH
Other - Last Name:BOWEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9100 CHURCH ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110
Mailing Address - Country:US
Mailing Address - Phone:703-530-1360
Mailing Address - Fax:703-530-1362
Practice Address - Street 1:9300 FOREST POINT CR
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110
Practice Address - Country:US
Practice Address - Phone:703-622-4253
Practice Address - Fax:703-622-4254
Is Sole Proprietor?:No
Enumeration Date:2008-05-03
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040061811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical