Individual
DR. DEIRDRE RENEE' JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD LCMHCS LPC NCC
Contact information
Practice address
1059 SPICER DR, CLARKSVILLE, TN 37042-2120
(615) 473-5152
Mailing address
1059 SPICER DR, CLARKSVILLE, TN 37042-2120
(615) 473-5152
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
S12958
NC
101YP2500X
Professional Counselor
1744
TN
101YP2500X
Professional Counselor
Primary
5911
LA
101YP2500X
Professional Counselor
77544
TX
Other
Enumeration date
07/01/2014
Last updated
07/20/2022
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