| Doctor Name: | NATOYA JACKSON |
| NPI Number: | 1225157498 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MA, LPC, NCC |
| License Number: | 5317 |
| Business Practice Address: | 121 S Main St Kernersville, NC - 272842757 |
| Business Phone Number: | 3369960631 |
| Business Fax Number: | 3369965712 |
| Mailing Address: | 121 S Main St, KERNERSVILLE |
| State: | NC |
| Postal Code: | 272842757 |
| Phone Number: | 3369960631 |
| Fax Number: | 3369965712 |
| NPI Enumeration Date: | 03/28/2007 |
| NPI Last Update Date: | 09/01/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 5317 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NC |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |