Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
MS. MARY THERESA JACKSON, LPC
Active Sole ProprietorMS. MARY THERESA JACKSON, LPC is a Professional Counselor healthcare provider located in ELLABELL, Georgia. NPI 1699121129 is currently active in the NPPES registry. Verify at CMS.
Professional Counselor · ELLABELL, GA
Registration Details
- NPI Number
- 1699121129
- Provider Type
- Individual
- Gender
- Female
- NPI Issued
- May 13, 2016 (10.233364413558 yrs)
- Last Updated
- Nov 27, 2023
- License
-
LPC011711 (GA)
- Sole Proprietor
- Yes
Practice Information
- Address
-
345 OLD CUYLER RDELLABELL, GA, 313085858Browse GA providers · Browse ZIP 31308
- Phone
- 9123203205
- Primary Specialty
-
Professional Counselor
101YP2500X
- Additional Specialty
- Professional Counselor
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.