# DR. JANISSA D JACKSON

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1043365620
- **Gender:** F
- **Credential:** PHD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103TC0700X | Clinical Psychologist | 07-01P | AR | — |
| 103TC2200X | Clinical Child & Adolescent Psychologist | 07-01P | AR | Yes |

## Other

- **Enumeration date:** 01/24/2007
- **Last updated:** 10/17/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 5A252 | BLUECROSS BLUESHIELD | AR |