Individual
MS. LILLIAN MALINDA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCAS
Contact information
Practice address
3000 FALSTAFF RD, RALEIGH, NC 27610-1813
(919) 250-1260
Mailing address
3000 FALSTAFF RD, RALEIGH, NC 27610-1813
(919) 250-1260
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1524
NC
Other
Enumeration date
03/10/2010
Last updated
11/12/2010
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