Individual
MRS. KATHERINE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, LMFTA
Contact information
Practice address
6604 SIX FORKS RD, RALEIGH, NC 27615-6521
(919) 725-8086
Mailing address
10204 RIVER BANK DR, RALEIGH, NC 27614-8928
(919) 332-1517
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
12495A
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12495A
LICENSE NUMBER
NC
Enumeration date
12/22/2022
Last updated
12/22/2022
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