Individual
JAQUELLA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW
Contact information
Practice address
804 NOTRE DAME AVE, ALBANY, GA 31705-4324
(229) 376-0286
Mailing address
804 NOTRE DAME AVE, ALBANY, GA 31705-4324
(229) 376-0286
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
101YM0800X
Mental Health Counselor
—
—
104100000X
Social Worker
—
—
106S00000X
Behavior Technician
—
—
Other
Enumeration date
12/09/2025
Last updated
12/09/2025
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