Doctor Name: | LORA J JACKSON |
NPI Number: | 1013228519 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MS, LPC, NCC |
License Number: | LC2939 |
Business Practice Address: | 110 W Main St Everett, PA - 155371131 |
Business Phone Number: | 8146522650 |
Business Fax Number: | |
Mailing Address: | Po Box 398, 10309 Greenwood Street ELLERSLIE |
State: | MD |
Postal Code: | 215290398 |
Phone Number: | 3016976199 |
Fax Number: | |
NPI Enumeration Date: | 06/29/2010 |
NPI Last Update Date: | 06/29/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101Y00000X |
License Number: | LC2939 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | MD |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |