Individual
DR. ANITA P JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
573 BROOKOVER AVE, ZANESVILLE, OH 43701-2101
(740) 450-7620
(740) 450-7618
Mailing address
573 BROOKOVER AVE, ZANESVILLE, OH 43701-2101
(740) 450-7620
(740) 450-7618
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
E1514
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000517637
ANTHEM
OH
01
—
311814468031
CARESOURCE
OH
Enumeration date
01/04/2007
Last updated
11/28/2007
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