| Doctor Name: | JUDITH C. JACKSON |
| NPI Number: | 1942217401 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCSW |
| License Number: | |
| Business Practice Address: | 5841 Us 421 South Buies Creek, NC - 27506 |
| Business Phone Number: | 9108935727 |
| Business Fax Number: | 9108936404 |
| Mailing Address: | Po Box 9, 1120 Seven Lakes Drive WEST END |
| State: | NC |
| Postal Code: | 273760009 |
| Phone Number: | 9106739111 |
| Fax Number: | 9106736202 |
| NPI Enumeration Date: | 08/01/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |