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Individual
SARAH C JACKSON
Active
Individual
SARAH C JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW, CSAC
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
0710000240
VA
1041C0700X
Clinical Social Worker
Primary
0904003115
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
086361
SENTARA
VA
01
—
258581
ANTHEM
VA
05
—
4945280
—
VA
Enumeration date
07/07/2006
Last updated
04/29/2008
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