Individual
ELIJAH JAGGER JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
201 S 13TH ST APT 1011, PHILADELPHIA, PA 19107-5404
(631) 346-8485
Mailing address
201 S 13TH ST APT 1011, PHILADELPHIA, PA 19107-5404
(631) 346-8485
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
—
—
1041C0700X
Clinical Social Worker
Primary
CW023481
PA
Other
Enumeration date
05/30/2020
Last updated
05/29/2023
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