Individual
CIERRA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPCC
Contact information
Practice address
1560 CALDER CT, FAIRBORN, OH 45324
(937) 270-6259
Mailing address
1560 CALDER CT, FAIRBORN, OH 45324-6904
(937) 270-6259
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
141105
OH
101YM0800X
Mental Health Counselor
E.2001672
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0431711
—
OH
Enumeration date
12/01/2015
Last updated
07/11/2024
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