| Doctor Name: | MS. PAMELA L. JACKSON |
| NPI Number: | 1518141704 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCPC |
| License Number: | LC2204 |
| Business Practice Address: | 190 Marchand Dr Apartment 1 Westover, WV - 265013895 |
| Business Phone Number: | 4438690072 |
| Business Fax Number: | |
| Mailing Address: | 190 Marchand Dr, Apartment 1 WESTOVER |
| State: | WV |
| Postal Code: | 265013895 |
| Phone Number: | 4438690072 |
| Fax Number: | |
| NPI Enumeration Date: | 12/24/2007 |
| NPI Last Update Date: | 07/24/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | LC2204 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MD |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |