Provider Demographics
NPI:1780316406
Name:MICHEL, JACQUESTA TAMEKIA (LCSW)
Entity type:Individual
Prefix:
First Name:JACQUESTA
Middle Name:TAMEKIA
Last Name:MICHEL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 PINEWALK DR N APT 1924
Mailing Address - Street 2:
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-7843
Mailing Address - Country:US
Mailing Address - Phone:954-861-7256
Mailing Address - Fax:
Practice Address - Street 1:3300 PINEWALK DR N APT 1924
Practice Address - Street 2:
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063-7843
Practice Address - Country:US
Practice Address - Phone:954-861-7256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW201501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical