Individual
EMILY JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ALC
Contact information
Practice address
9869 PULASKI PIKE UNIT C, TONEY, AL 35773-7201
(256) 850-4091
Mailing address
9869 PULASKI PIKE UNIT C, TONEY, AL 35773-7201
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
ALC04779
AL
106S00000X
Behavior Technician
RBT-21-190282
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ALC04779
ALABAMA BOARD OF EXAMINERS IN COUNSELING
AL
01
—
RBT-21-190282
BACB
—
Enumeration date
02/08/2022
Last updated
01/31/2024
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