Individual
MS. BETHENA M JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CSAC, LCAS-A
Contact information
Practice address
2604 CARVER ST, SUITE C, DURHAM, NC 27705-2796
(919) 682-4771
(919) 683-2641
Mailing address
2109 PEAR TREE LN, DURHAM, NC 27703-6280
(919) 633-8360
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
2421
NC
Other
Enumeration date
12/15/2012
Last updated
12/15/2012
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