Provider Demographics
NPI:1831541481
Name:JACQUELINE POLLOK, LPCC, LLC
Entity type:Organization
Organization Name:JACQUELINE POLLOK, LPCC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:POLLOK
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC, LICDC
Authorized Official - Phone:614-842-7999
Mailing Address - Street 1:1170 OLD HENDERSON RD
Mailing Address - Street 2:SUITE 216
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-3623
Mailing Address - Country:US
Mailing Address - Phone:614-842-7999
Mailing Address - Fax:
Practice Address - Street 1:1170 OLD HENDERSON RD
Practice Address - Street 2:SUITE 216
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-3623
Practice Address - Country:US
Practice Address - Phone:614-842-7999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-07
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health