Organization
AI COUNSELING SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AQUANATTE JACKSON LCSW (CEO)
(256) 797-1363
Entity
Organization
Contact information
Practice address
5059 HAYES ST, GARY, IN 46408-4355
(256) 797-1363
Mailing address
5059 HAYES ST, GARY, IN 46408-4355
(256) 797-1363
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
103TC1900X
Counseling Psychologist
—
—
104100000X
Social Worker
Primary
—
—
1041C0700X
Clinical Social Worker
—
—
106H00000X
Marriage & Family Therapist
—
—
2084P0800X
Psychiatry Physician
—
—
Other
Enumeration date
06/19/2018
Last updated
03/28/2025
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