Provider Demographics
NPI:1699936369
Name:MAFFETT, JACQUELINE E (LPC)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:E
Last Name:MAFFETT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3210 FAIRHILL DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-3215
Mailing Address - Country:US
Mailing Address - Phone:919-256-0824
Mailing Address - Fax:919-256-0833
Practice Address - Street 1:3708 MAYFAIR ST
Practice Address - Street 2:SOUTH SQUARE 2
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-6226
Practice Address - Country:US
Practice Address - Phone:919-683-1800
Practice Address - Fax:919-490-5893
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-24
Last Update Date:2010-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7055101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6103933Medicaid