Individual
CAROLYN DENISE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW, LCAS-A
Contact information
Practice address
3205 RANDALL PKWY STE 121, WILMINGTON, NC 28403
(910) 520-6083
Mailing address
3205 RANDALL PKWY STE 121, WILMINGTON, NC 28403-2567
(910) 520-6083
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
22913
NC
1041C0700X
Clinical Social Worker
Primary
C011298
NC
Other
Enumeration date
08/07/2009
Last updated
05/04/2019
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