Individual
ALICIA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.A., C.M.H.S.
Contact information
Practice address
720 14TH AVE., LONGVIEW, WA 98632
(360) 423-0203
(360) 423-5086
Mailing address
921 14TH AVENUE, LONGVIEW, WA 98632
(360) 423-0203
(360) 577-0269
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
60926696
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2097719
—
WA
Enumeration date
09/26/2012
Last updated
03/06/2019
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