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Individual
MRS. PATRICE LYNETTE JACKSON
Active
Individual
MRS. PATRICE LYNETTE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
0701008703
VA
101YA0400X
Addiction (Substance Use Disorder) Counselor
0701008703
VA
101YM0800X
Mental Health Counselor
0701008703
VA
101YP2500X
Professional Counselor
Primary
0701008703
VA
Other
Enumeration date
12/18/2019
Last updated
12/18/2019
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