Doctor Name: | DR. TONJANIKA JACKSON |
NPI Number: | 1821495961 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PHD |
License Number: | CPD0044 |
Business Practice Address: | 4122 Pinnacle Way Hephzibah, GA - 308156152 |
Business Phone Number: | 7067728079 |
Business Fax Number: | 7067728079 |
Mailing Address: | 4122 Pinnacle Way, HEPHZIBAH |
State: | GA |
Postal Code: | 308156152 |
Phone Number: | 7067728079 |
Fax Number: | 7067728079 |
NPI Enumeration Date: | 12/03/2014 |
NPI Last Update Date: | 12/03/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | CPD0044 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | GA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |