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General NPI Number Information
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NPI Number | 1295080240
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Entity Type | Individual
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Provider Name | JACQUELYN MICHELLE HORTON LICSW
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Gender | Female
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Dates
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Enumeration Date | 07/16/2012
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Last Update Date | 08/16/2021
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Provider Practice Location Address
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Address Line | 1160 VARNUM ST NE STE 110
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City | WASHINGTON
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State | DC
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Zip | 20017-2106
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Country | US
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Telephone | 202-854-4090
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Fax | 202-854-4093
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Provider Business Mailing Address
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Address Line | 1838 4TH ST NW 1B
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City | WASHINGTON
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State | DC
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Zip | 20001-1822
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Country | US
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Telephone | 202-390-3288
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 50076777
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License Number State | DC
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