Individual
ELAINE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCPC
Contact information
Practice address
325 CHERRY ST, PHILADELPHIA, PA 19106-2061
(202) 780-5333
Mailing address
325 CHERRY ST, PHILADELPHIA, PA 19106-2061
(202) 780-5333
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
0701010327
VA
101YM0800X
Mental Health Counselor
Primary
LC9062
MD
101YM0800X
Mental Health Counselor
LGP7431
MD
101YM0800X
Mental Health Counselor
LGPC00898
DC
Other
Enumeration date
11/02/2016
Last updated
04/10/2023
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