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Individual

DR. ANGELA DECARLA JACKSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PH.D., LCPC, LMHC

Contact information

Practice address
1251 N EDDY ST STE 200, SOUTH BEND, IN 46617-1478
(312) 798-9755
Mailing address
1251 N EDDY ST STE 200, SOUTH BEND, IN 46617-1478
(312) 798-9755

Taxonomy

Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
180.011258
IL
101YP2500X
Professional Counselor
Primary
39004648A
IN

Other

Enumeration date
11/17/2016
Last updated
06/25/2025
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