Individual
DIANE CATHLEEN JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
806 HAY ST, FAYETTEVILLE, NC 28305-5312
(910) 822-3333
(910) 822-3336
Mailing address
806 HAY ST, FAYETTEVILLE, NC 28305-5312
(910) 822-3333
(910) 822-3336
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
C004576
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
136K7
BCBS OF NC
NC
05
—
6003734
—
NC
Enumeration date
06/07/2006
Last updated
09/26/2011
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