Provider Demographics
NPI:1730697905
Name:JACQUES, BARBARA (LMFTA)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:JACQUES
Suffix:
Gender:F
Credentials:LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6831 GLASS POND CT SW
Mailing Address - Street 2:
Mailing Address - City:OCEAN ISLE BEACH
Mailing Address - State:NC
Mailing Address - Zip Code:28469-5578
Mailing Address - Country:US
Mailing Address - Phone:410-707-3246
Mailing Address - Fax:
Practice Address - Street 1:3806 PEACHTREE AVE STE 210
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6752
Practice Address - Country:US
Practice Address - Phone:910-251-7789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-22
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12236A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist