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General NPI Number Information
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NPI Number | 1558485045
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Entity Type | Individual
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Provider Name | JACQUELINE BAXLEY MS, LPC, ACS
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Gender | Female
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 11/11/2024
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Provider Practice Location Address
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Address Line | 1139 E JERSEY ST STE 417
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City | ELIZABETH
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State | NJ
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Zip | 07201-2446
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Country | US
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Telephone | 908-662-3200
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Fax | 908-662-3202
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Provider Business Mailing Address
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Address Line | 911 WORTH AVE
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City | ELIZABETH
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State | NJ
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Zip | 07201-2446
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Country | US
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Telephone | 84-635-5149
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 37PC0040200
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License Number State | NJ
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