Provider Demographics
NPI:1811944408
Name:WASHKWICH, JACQUE LYNNE (PHD)
Entity type:Individual
Prefix:DR
First Name:JACQUE LYNNE
Middle Name:
Last Name:WASHKWICH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 JOYNER AVE
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28806-4307
Mailing Address - Country:US
Mailing Address - Phone:828-280-2274
Mailing Address - Fax:
Practice Address - Street 1:27 JOYNER AVE
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28806-4307
Practice Address - Country:US
Practice Address - Phone:828-280-2274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-28
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2872103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCQ431900281Medicaid
NC6000533Medicaid