Doctor Name: | MS. NICOLE M. JACKSON |
NPI Number: | 1205017803 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MA, LPC, LCADC |
License Number: | 37PC00345200 |
Business Practice Address: | 232 Norwood Ave Suite 5 West Long Branch, NJ - 077641859 |
Business Phone Number: | 7329482132 |
Business Fax Number: | |
Mailing Address: | 232 Norwood Ave, Suite 5 WEST LONG BRANCH |
State: | NJ |
Postal Code: | 077641859 |
Phone Number: | 7329482132 |
Fax Number: | |
NPI Enumeration Date: | 11/25/2007 |
NPI Last Update Date: | 09/29/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101Y00000X |
License Number: | 37PC00345200 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | NJ |
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 |