Individual
ANNA MARIE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
96 PARK ST, MONTCLAIR, NJ 07042-2929
(973) 868-8729
Mailing address
5 MACOPIN AVE, MONTCLAIR, NJ 07043-2001
(207) 281-2037
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
37AC00294500
NJ
101YP2500X
Professional Counselor
Primary
37PC00689300
NJ
Other
Enumeration date
08/15/2016
Last updated
09/30/2021
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