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Individual
IRENE DORMENIE JACKSON
Active
Individual
IRENE DORMENIE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCMHC, LCAS-A
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
LCAS-26084
NC
101YM0800X
Mental Health Counselor
Primary
16165
NC
Other
Enumeration date
09/18/2020
Last updated
10/24/2024
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