Individual
MS. DIANA SUE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMHC, CADC
Contact information
Practice address
1744 2ND AVE SE, CEDAR RAPIDS, IA 52403-2306
(319) 366-4673
Mailing address
4101 HICKORY HILL LN, CEDAR RAPIDS, IA 52403-3740
(319) 213-3775
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
14116
IA
101YM0800X
Mental Health Counselor
Primary
079713
IA
Other
Enumeration date
08/25/2016
Last updated
05/01/2019
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