Individual
MR. JAISSEN M JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMHC
Contact information
Practice address
194 WEBSTER AVE, PROVIDENCE, RI 02909-3818
(401) 261-0321
Mailing address
530 N MAIN ST, PROVIDENCE, RI 02904-5762
(401) 276-4100
(401) 276-4124
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
MHC01094
RI
Other
Enumeration date
03/13/2017
Last updated
10/10/2025
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