Individual
JACQUELINE NICOLE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BSPM/BA/MSFP
Contact information
Practice address
174 SCHOLAR RD, GUYTON, GA 31312-6240
(912) 231-7061
Mailing address
174 SCHOLAR RD, GUYTON, GA 31312-6240
(912) 231-7061
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YM0800X
Mental Health Counselor
Primary
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
Other
Enumeration date
01/08/2026
Last updated
01/08/2026
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