Provider Demographics
NPI:1487886933
Name:CARLISLE-BERKLEY, JACQUELINE RAE (LPC-MHSP)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:RAE
Last Name:CARLISLE-BERKLEY
Suffix:
Gender:F
Credentials:LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 HILLCREST DR
Mailing Address - Street 2:SUITE 204
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-5064
Mailing Address - Country:US
Mailing Address - Phone:931-494-6803
Mailing Address - Fax:
Practice Address - Street 1:130 HILLCREST DR
Practice Address - Street 2:SUITE 204
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-5064
Practice Address - Country:US
Practice Address - Phone:931-494-6803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-18
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3208101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health