Individual
MS. NICOLE M. JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, LPC, LCADC
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
37PC00345200
NJ
101YA0400X
Addiction (Substance Use Disorder) Counselor
37LC00119500
NJ
101YP2500X
Professional Counselor
Primary
37PC00345200
NJ
Other
Enumeration date
11/25/2007
Last updated
09/29/2008
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