Healthcare Provider Details

I. General information

NPI: 1013536614
Provider Name (Legal Business Name): JACQUELYN PATRICE BATTLE LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MRS. JACQUELYN PATRICE BATTLE

II. Dates (important events)

Enumeration Date: 04/13/2020
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2262 E HAZELTINE WAY
CHANDLER AZ
85249-4641
US

IV. Provider business mailing address

2262 E HAZELTINE WAY
CHANDLER AZ
85249-4641
US

V. Phone/Fax

Practice location:
  • Phone: 919-702-3006
  • Fax:
Mailing address:
  • Phone: 919-702-3006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSWB20250994
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: