Doctor Name: | JACQUELINE CAUPRICE CLANCE |
NPI Number: | 1407042146 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.S., L.P.C. |
License Number: | LPC006562 |
Business Practice Address: | 549 Fieldwood Dr Nw Adairsville, GA - 301035369 |
Business Phone Number: | 7062638252 |
Business Fax Number: | |
Mailing Address: | 549 Fieldwood Dr Nw, ADAIRSVILLE |
State: | GA |
Postal Code: | 301035369 |
Phone Number: | 7062638252 |
Fax Number: | |
NPI Enumeration Date: | 09/17/2007 |
NPI Last Update Date: | 12/27/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | LPC006562 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |