Doctor Name: | MR. THOMAS JACKSON |
NPI Number: | 1255698759 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.S.W., P-LCSW |
License Number: | P006086 |
Business Practice Address: | 5240 Creed Dr Summerfield, NC - 273588284 |
Business Phone Number: | 3366861314 |
Business Fax Number: | 3366861314 |
Mailing Address: | 5240 Creed Dr, SUMMERFIELD |
State: | NC |
Postal Code: | 273588284 |
Phone Number: | 3366861314 |
Fax Number: | 3366861314 |
NPI Enumeration Date: | 04/20/2012 |
NPI Last Update Date: | 04/20/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | P006086 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NC |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |