Provider Demographics
NPI:1700677150
Name:GREEN-HANCOCK, JACQUELYN D (BA, MSW, LCSW-S)
Entity type:Individual
Prefix:MRS
First Name:JACQUELYN
Middle Name:D
Last Name:GREEN-HANCOCK
Suffix:
Gender:F
Credentials:BA, MSW, LCSW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 GRAYSON AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23222-1352
Mailing Address - Country:US
Mailing Address - Phone:804-706-8491
Mailing Address - Fax:
Practice Address - Street 1:605 GRAYSON AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23222-1352
Practice Address - Country:US
Practice Address - Phone:804-706-8491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-15
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09060154931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical