Individual
DR. CHARLES W JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
210 UNIVERSITY PLAZA DR, CONWAY, SC 29526-8978
(843) 347-2550
Mailing address
5315 N KINGS HWY, PMB 120, MYRTLE BEACH, SC 29577-2534
(843) 503-2000
(843) 272-3032
Taxonomy
Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
Primary
182
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
182
COUNSELING PSYCHOLOGIST
SC
Enumeration date
07/26/2006
Last updated
07/08/2007
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