Individual
ANNA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
112 N BROAD ST, PHILADELPHIA, PA 19102-1512
(215) 568-0860
Mailing address
519 E HARRIS ST, SAVANNAH, GA 31401-4621
(912) 695-7021
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YP2500X
Professional Counselor
LPC014016
GA
101YP2500X
Professional Counselor
Primary
PC011832
PA
Other
Enumeration date
08/23/2019
Last updated
12/12/2024
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