Individual
LISA NANCHES JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
920 BELLEVUE ST SE, WASHINGTON, DC 20032-6030
(202) 562-4939
Mailing address
920 BELLEVUE ST SE, WASHINGTON, DC 20032-6030
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CACII1408
DC
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CACII1408
CAC II
DC
Enumeration date
05/29/2023
Last updated
12/03/2024
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