JACQUELINE LATRICIA SLACK (NPI# 1871806992) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1871806992 |
| Entity Type | Individual |
| Full Name | JACQUELINE LATRICIA SLACK |
| Credential | LPC, NCC |
| Practice Address |
217 Arrowhead Blvd Ste A4 Jonesboro GA 30236-1169 |
| Mailing Address |
3695f Cascade Rd Sw # 2237 Atlanta GA 30331-2105 |
| Practice Telephone | 4042267553 |
| Practice Fax Number | 4045058469 |
| Mailing Telephone | 4042267553 |
| Mailing Fax Number | 4045058469 |
| Enumeration Date | 2010-07-18 |
| Last Update Date | 2010-07-18 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101Y00000X | Counselor | LPC005620 | GA | Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396914453 | Jacqueline May Slack | Registered Nurse | 4455 Rt 414, Seneca Falls, NY 13148-9531 | 2008-02-22 |
| Street Address |
217 ARROWHEAD BLVD STE A4 |
| City | JONESBORO |
| State | GA |
| Zip Code | 30236-1169 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972123362 | Life Source Counseling & Consulting, LLC | Clinic/Center | 118 North Avenue, Suite A, Jonesboro, GA 30236 | 2020-04-25 |
| 1639609555 | New Beginnings Behavioral Counseling,llc | Social Worker | 9456 S Main St Ste E2, Jonesboro, GA 30236 | 2017-06-13 |
| 1437696762 | Clarissa Alexandra Poole | Counselor | 2106 Fair Ridge Ct, Jonesboro, GA 30236 | 2017-01-25 |
| 1588012892 | Sundance Healthcare Service Inc | In Home Supportive Care | 7861 Collinswood Court, Jonesboro, GA 30236 | 2016-05-26 |
| 1942669205 | Adrianne Smiley Gurley | Occupational Therapist | 1299 Battlecreek Rd Ste 210, Jonesboro, GA 30236 | 2016-02-15 |
| 1336505809 | Integrated Health Center | Dentist | 8600 Tara Blvd, Suite D, Jonesboro, GA 30236 | 2016-01-13 |
| 1467827402 | Surrell Porter | Nurse Practitioner | 1287 Georgia Highway 138 Spur, Suite 8, Jonesboro, GA 30236 | 2015-12-02 |
| 1740688910 | Jacqueline Carolyn Edwards | Registered Nurse | 8081 Tara Blvd, 265, Jonesboro, GA 30236 | 2014-12-19 |
| 1770991861 | Lower Extremity Diagnostics, LLC | Podiatrist | 6911 Tara Boulevard, Jonesboro, GA 30236 | 2014-08-01 |
| 1760899710 | Fresenius Medical Care Jonesboro, LLC | Clinic/Center | 8060 Summitt Business Parkway, Jonesboro, GA 30236 | 2014-07-22 |
| Find all providers in zip 30236 | ||||
| Taxonomy Code | 101Y00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master’s degree and clinical experience and supervision for licensure or certification. |
| Notes: Sources: Abridged from definitions provided by the National Board of Certified Counselors and the American Association of Pastoral Counselors. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538779764 | Overcoming: A Private Therapy Practice, LLC | Counselor | 922 E Craighead Forest Rd Apt N, Jonesboro, AR 72404-8307 | 2020-08-03 |
| 1992346746 | June Paulette Edwards | Counselor | 7697 Highland Park Dr, Jonesboro, GA 30236-2771 | 2019-10-02 |
| 1841758307 | Ericka L Williams | Counselor | 118 North Ave Ste K, Jonesboro, GA 30236-8408 | 2019-03-04 |
| 1366950958 | Connections Counseling Center | Counselor | 300 Mardis Dr, Jonesboro, AR 72404-0525 | 2018-01-17 |
| 1912432188 | Wakako Minamotowood | Counselor | 7744 Newbury Dr, Jonesboro, GA 30236-7312 | 2017-04-25 |
| 1992162358 | Donna K. Batchelor-coleman | Counselor | 1557 Teal Pl, Jonesboro, GA 30236-5055 | 2016-01-15 |
| 1770974461 | Faith Open Door Community Center, Inc. | Counselor | 259 Arrowhead Blvd, C2, Jonesboro, GA 30236-1167 | 2015-02-17 |
| 1639504988 | Taelor F. Blankenship | Counselor | 3700 Access Rd, Jonesboro, AR 72401-8225 | 2013-09-05 |
| 1508112269 | Barbara Jean Beeler | Counselor | 8955 Fayetteville Rd, Jonesboro, GA 30238-4815 | 2012-07-31 |
| 1538461546 | Positive Psychotherapy Services | Counselor | 1504 Merrywood Dr, Jonesboro, AR 72401-5107 | 2010-11-23 |
| Find all providers in JONESBORO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.