Individual
AMBER ADNEY JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
528 N COLLEGE AVE STE 2, FAYETTEVILLE, AR 72701-3401
(479) 856-9956
(888) 455-6401
Mailing address
528 N COLLEGE AVE STE 2, FAYETTEVILLE, AR 72701-3401
(479) 856-9956
(888) 455-6401
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
1934-C
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5Y354
BLUE SHIELD PROVIDER #
AR
01
—
747768
BEACON HEALTH
—
Enumeration date
05/31/2006
Last updated
12/15/2021
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