Jacquline Nicole Pridemore, MA, LPCC-S

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

E.1901080-SUPV Issued in OH

Practice address

4633 Aicholtz Rd
Cincinnati, OH 45244-1447

Phone

(513) 752-1555

NPI assigned

Jan 3, 2017

Last updated

Aug 4, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other names 1

• Jacquline Nicole Watson Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1483401600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1596499200000",
    "number": "1407391295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4629 AICHOLTZ RD",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452441551",
            "telephone_number": "937-403-5251"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4633 AICHOLTZ RD",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452441447",
            "telephone_number": "513-752-1555"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1449 Emerson Ln",
            "address_purpose": "LOCATION",
            "city": "Milford",
            "state": "OH",
            "postal_code": "451502422",
            "country_code": "US",
            "telephone_number": "937-403-5251",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PRIDEMORE",
        "first_name": "JACQULINE",
        "middle_name": "NICOLE",
        "credential": "MA, LPCC-S",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-01-03",
        "last_updated": "2020-08-04",
        "certification_date": "2020-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OH",
            "license": "C1500158",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "OH",
            "license": "E.1901080",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "OH",
            "license": "E.1901080-SUPV",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACQULINE",
            "last_name": "WATSON",
            "middle_name": "NICOLE",
            "credential": "MA, LPCC-S",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Tippi Price
• Trent Price
• Anthony James Prickel, APRN-CRNA
• Derek Pride
• Gare'T A Pride
• Candace Priest, RN
• Sarah Maria Priestle, PHARMD
• Inma C Prieto, M.D.
• Ilana Beila Primack, MD
• Primary Care of Cincinnati Inc

• Professional Counselor in Cincinnati, OH
• Providers in Cincinnati, OH by specialty
• Professional Counselor in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.