Individual
NATASHA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCAS-A
Contact information
Practice address
1302 WILLOW ST, GREENVILLE, NC 27858-1405
(252) 508-2173
Mailing address
1302 WILLOW ST, GREENVILLE, NC 27858-1405
(252) 508-2173
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
23120
NC
Other
Enumeration date
10/15/2018
Last updated
10/15/2018
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