Individual
MS. CATHY GAIL JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCPC
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
180006774
IL
101YP2500X
Professional Counselor
Primary
180006774
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
474549320
—
IL
Enumeration date
12/18/2009
Last updated
04/21/2022
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