Individual
MISS LENA CITIRAH JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCAS, LCMHC
Contact information
Practice address
1724 ROXIE AVE, FAYETTEVILLE, NC 28304-1623
(910) 778-5900
(919) 758-9317
Mailing address
11361 N 99TH AVE STE 402, PEORIA, AZ 85345-5459
(602) 650-1212
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
2211
NC
101YM0800X
Mental Health Counselor
12462
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
18291
BCBS
NC
Enumeration date
04/26/2007
Last updated
11/18/2025
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