Provider Demographics
NPI:1780101501
Name:BARKSDALE, JACQUELINE LEE (LCSW)
Entity type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:LEE
Last Name:BARKSDALE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3555 COMMONWEALTH BLVD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSE
Mailing Address - State:FL
Mailing Address - Zip Code:32303
Mailing Address - Country:US
Mailing Address - Phone:850-504-5021
Mailing Address - Fax:
Practice Address - Street 1:975 COMMONWEALTH BLVD
Practice Address - Street 2:
Practice Address - City:TALLAHASSE
Practice Address - State:FL
Practice Address - Zip Code:32303
Practice Address - Country:US
Practice Address - Phone:850-504-5021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW32571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical