Individual
CARMELLA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
261 OLD YORK RD STE 709, JENKINTOWN, PA 19046-3728
(215) 690-1004
(267) 907-1120
Mailing address
7973 THOURON AVE, 2ND FLOOR, PHILADELPHIA, PA 19150-2520
(267) 307-9700
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
8062
PA
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
Primary
PC007622
PA
101YM0800X
Mental Health Counselor
—
—
Other
Enumeration date
06/29/2015
Last updated
11/14/2023
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