Individual
SARAH TINA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
8117 EBENEZER CHURCH RD, RALEIGH, NC 27612-7307
(984) 263-0654
Mailing address
509 HANSKA WAY, RALEIGH, NC 27610-2265
(856) 558-0259
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-22-63279
NC
106S00000X
Behavior Technician
—
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1-22-63279
BACB
NC
Enumeration date
09/22/2019
Last updated
04/19/2024
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