| Doctor Name: | MR. ADAYIS MARSHAY JACKSON |
| NPI Number: | 1003264086 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | L.C.D.C |
| License Number: | 12026 |
| Business Practice Address: | 8711 Burnet Rd Ste. A-3 Austin, TX - 787577043 |
| Business Phone Number: | 5122570066 |
| Business Fax Number: | 5124590499 |
| Mailing Address: | 8711 Burnet Rd Ste. A-3, AUSTIN |
| State: | TX |
| Postal Code: | 78757 |
| Phone Number: | 5122570066 |
| Fax Number: | 5124590499 |
| NPI Enumeration Date: | 05/31/2016 |
| NPI Last Update Date: | 05/31/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 12026 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |