Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
JALISA JACKSON
Active Sole ProprietorPsychiatric Residential Treatment Facility · CHARLOTTE, NC
Registration Details
- NPI Number
- 1366041667
- Provider Type
- Individual
- Gender
- Female
- NPI Issued
- Oct 19, 2020 (5.5073994197028 yrs)
- Last Updated
- Oct 19, 2020
- License
-
MHL-036-348 (NC)
- Sole Proprietor
- Yes
Practice Information
- Address
-
11413 MANGLA DRCHARLOTTE, NC, 282148885Browse NC providers · Browse ZIP 28214
- Phone
- 7048194909
- Primary Specialty
-
Psychiatric Residential Treatment Facility
320800000X
Other Psychiatric Residential Treatment Facility Providers in CHARLOTTE, NC
| Name | Credential | NPI |
|---|---|---|
| MRS. PATSY Y. CAMP | — | 1649310400 |
| WHITTNEY WILLIAMS | — | 1003508490 |
| ROBIN ROBERSON | — | 1932978004 |
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.