MEDICARE: JACQUIE DRURY LPCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	E.1700414	OH

General Provider Information

NPI Number	:	1326417973
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUIE DRURY LPCC

Provider Business Mailing Address
First Line	:	1500 CHESTNUT ST # 1188
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19102-2737
Country	:	US
Telephone Number	:	513-399-7095
Fax Number	:

Provider Business Practice Location Address
First Line	:	921 N HANCOCK ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19123-2303
Country	:	US
Telephone Number	:	513-399-7095
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/24/2015
Last Update Date	:	01/26/2022

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