Doctor Name: | VANESSA JACKSON |
NPI Number: | 1063812451 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.S. |
License Number: | BH001472 |
Business Practice Address: | 4800 Pine St Apt A102 Phila, PA - 191431749 |
Business Phone Number: | 2678199706 |
Business Fax Number: | |
Mailing Address: | 4800 Pine St Apt A102, PHILA |
State: | PA |
Postal Code: | 191431749 |
Phone Number: | 2678199706 |
Fax Number: | |
NPI Enumeration Date: | 09/04/2014 |
NPI Last Update Date: | 09/04/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | BH001472 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |