| Doctor Name: | MS. CASSONDRA JACKSON |
| NPI Number: | 1346633229 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | APC |
| License Number: | APC004749 |
| Business Practice Address: | 1076 Hawthorn Ln Grayson, GA - 300174208 |
| Business Phone Number: | 6784929332 |
| Business Fax Number: | |
| Mailing Address: | 1076 Hawthorn Ln, GRAYSON |
| State: | GA |
| Postal Code: | 300174208 |
| Phone Number: | 6784929332 |
| Fax Number: | |
| NPI Enumeration Date: | 03/16/2015 |
| NPI Last Update Date: | 03/16/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | APC004749 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |