# KENDRICK JACKSON

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1013391176
- **Gender:** Man

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101Y00000X | Counselor | — | LA | — |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | LA | — |
| 101YM0800X | Mental Health Counselor | — | LA | — |
| 101YP2500X | Professional Counselor | — | LA | — |
| 103K00000X | Behavior Analyst | — | LA | — |
| 103TC2200X | Clinical Child & Adolescent Psychologist | — | LA | — |
| 103TR0400X | Rehabilitation Psychologist | — | LA | — |
| 104100000X | Social Worker | — | LA | — |
| 1041C0700X | Clinical Social Worker | — | LA | — |
| 106H00000X | Marriage & Family Therapist | — | LA | Yes |

## Other

- **Enumeration date:** 07/17/2015
- **Last updated:** 07/17/2015