Individual
CHARLES BARTLETT JACKSON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
355 S MADISON BLVD STE C1, ROXBORO, NC 27573-5485
(336) 599-8366
(336) 322-6168
Mailing address
355 S MADISON BLVD STE C1, ROXBORO, NC 27573-5485
(336) 599-8366
(336) 322-6168
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
1513
NC
1041C0700X
Clinical Social Worker
Primary
C007168
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6112139
—
NC
Enumeration date
09/09/2009
Last updated
09/06/2015
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