Provider Demographics
NPI:1285379040
Name:LEYCOCK, JAQUAIN JERRY (LCSWA)
Entity type:Individual
Prefix:MR
First Name:JAQUAIN
Middle Name:JERRY
Last Name:LEYCOCK
Suffix:
Gender:M
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6637 HICKSBORO RD
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27565-5783
Mailing Address - Country:US
Mailing Address - Phone:718-200-0555
Mailing Address - Fax:
Practice Address - Street 1:6637 HICKSBORO RD
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:NC
Practice Address - Zip Code:27565-5783
Practice Address - Country:US
Practice Address - Phone:718-200-0555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-04
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0173441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty