Provider Demographics
NPI:1932206513
Name:POLLARD, JACKIE P (LPC, LMFT, MAC,NCC)
Entity type:Individual
Prefix:MISS
First Name:JACKIE
Middle Name:P
Last Name:POLLARD
Suffix:
Gender:F
Credentials:LPC, LMFT, MAC,NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 276
Mailing Address - Street 2:
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834-0276
Mailing Address - Country:US
Mailing Address - Phone:804-520-1655
Mailing Address - Fax:804-520-8595
Practice Address - Street 1:107 W ELLERSLIE AVE
Practice Address - Street 2:
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-1513
Practice Address - Country:US
Practice Address - Phone:804-520-1655
Practice Address - Fax:804-520-8595
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701001792103TC1900X
VA0717000056106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA085513OtherSENTARA BEHAVIORAL HEALTH
VA106008OtherANTHEM PROVIDER NUMBER
VA5906567OtherAETNA PROVIDER NUMBER
VA184246OtherUNITED HEALTH CARE/UBH
VA059404OtherVALUE OPTIONS NUMBER
VA246353OtherMHN/TRICARE
VA5400091Medicaid