Provider Demographics
NPI:1780563361
Name:JAKLIK, MARY ELIZABETH ANN (LCMHCA)
Entity type:Individual
Prefix:
First Name:MARY ELIZABETH
Middle Name:ANN
Last Name:JAKLIK
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10409 WYNDHAM FOREST DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-1511
Mailing Address - Country:US
Mailing Address - Phone:704-839-9034
Mailing Address - Fax:
Practice Address - Street 1:3021 SENNA DR
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-6727
Practice Address - Country:US
Practice Address - Phone:704-443-0144
Practice Address - Fax:704-476-1331
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-28
Last Update Date:2025-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA21929101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health