Provider Demographics
NPI:1841488574
Name:WITHERS, JACQUELINE HAIZLIP (LCSW)
Entity type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:HAIZLIP
Last Name:WITHERS
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 1:2698 SUGAR PINE RUN
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-9646
Mailing Address - Country:US
Mailing Address - Phone:407-366-6502
Mailing Address - Fax:
Practice Address - Street 1:2698 SUGAR PINE RUN
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-9646
Practice Address - Country:US
Practice Address - Phone:407-366-6502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW0039341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical