Individual
JOHNNIE MAC JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSW, CSW
Contact information
Practice address
7160 N MAYO TRL, PIKEVILLE, KY 41501-3151
(606) 657-9988
Mailing address
7160 N MAYO TRL, PIKEVILLE, KY 41501-3151
(606) 657-9988
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
254558
KY
101YM0800X
Mental Health Counselor
—
—
Other
Enumeration date
06/16/2016
Last updated
04/15/2022
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