Individual
JACQULINE NICOLE PRIDEMORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, LPCC-S
Contact information
Practice address
4633 AICHOLTZ RD, CINCINNATI, OH 45244-1447
(513) 752-1555
Mailing address
4629 AICHOLTZ RD, CINCINNATI, OH 45244-1551
(937) 403-5251
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
C1500158
OH
101YP2500X
Professional Counselor
E.1901080
OH
101YP2500X
Professional Counselor
Primary
E.1901080-SUPV
OH
Other
Enumeration date
01/03/2017
Last updated
08/04/2020
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