| Doctor Name: | MS. CAROLE INA JACKSON |
| NPI Number: | 1053546184 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LPCC |
| License Number: | 0132791 |
| Business Practice Address: | 1337 Gusdorf Road Suite E Taos, NM - 87571 |
| Business Phone Number: | 5757584297 |
| Business Fax Number: | 5757517237 |
| Mailing Address: | Po Box 237, EL PRADO |
| State: | NM |
| Postal Code: | 875290237 |
| Phone Number: | 5757762620 |
| Fax Number: | |
| NPI Enumeration Date: | 05/19/2009 |
| NPI Last Update Date: | 11/28/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 0132791 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NM |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |