Doctor Name: | NELL T JACKSON |
NPI Number: | 1902141427 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.A., L.P.C. |
License Number: | 37PC00090600 |
Business Practice Address: | 29 Olcott Sq Suite 2 Bernardsville, NJ - 079242306 |
Business Phone Number: | 9089539200 |
Business Fax Number: | 9089539220 |
Mailing Address: | 29 Olcott Sq, Suite 2 BERNARDSVILLE |
State: | NJ |
Postal Code: | 079242306 |
Phone Number: | 9089539200 |
Fax Number: | 9089539220 |
NPI Enumeration Date: | 12/10/2012 |
NPI Last Update Date: | 12/10/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 37PC00090600 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NJ |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |