Provider Demographics
NPI:1427732064
Name:JACKIE'S HOPE THERAPY, PLLC
Entity type:Organization
Organization Name:JACKIE'S HOPE THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KENYA
Authorized Official - Middle Name:NICHELLE
Authorized Official - Last Name:DUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:870-225-1187
Mailing Address - Street 1:3101 CARNABY ST APT E101
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72405-6008
Mailing Address - Country:US
Mailing Address - Phone:870-225-1187
Mailing Address - Fax:
Practice Address - Street 1:3101 CARNABY ST APT E101
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72405-6008
Practice Address - Country:US
Practice Address - Phone:870-225-1187
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty