Provider Demographics
NPI:1285960435
Name:FULCHER, JACQUELINE N (PHD, LMSW)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:N
Last Name:FULCHER
Suffix:
Gender:F
Credentials:PHD, LMSW
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:N
Other - Last Name:DAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:23327 N 44TH PL
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-8799
Mailing Address - Country:US
Mailing Address - Phone:520-981-0618
Mailing Address - Fax:
Practice Address - Street 1:23327 N 44TH PL
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85050-8799
Practice Address - Country:US
Practice Address - Phone:520-981-0618
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-22
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPSY-005312103TC0700X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical