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Individual
MARIE JACKA
Active
Individual
MARIE JACKA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LISW
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
8484
SC
101YM0800X
Mental Health Counselor
8484
SC
1041C0700X
Clinical Social Worker
8484
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
AD16DO
—
SC
Enumeration date
07/05/2007
Last updated
01/26/2012
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