Individual
MR. ADAM JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMFTA, SUDP
Contact information
Practice address
21324 SISTER SKY LN NE, INDIANOLA, WA 98342-9706
(360) 535-4535
Mailing address
21324 SISTER SKY LN NE, INDIANOLA, WA 98342-9706
(360) 535-4535
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CO60375850
WA
101YA0400X
Addiction (Substance Use Disorder) Counselor
CP60762987
WA
106H00000X
Marriage & Family Therapist
Primary
MG70044723
WA
Other
Enumeration date
04/18/2017
Last updated
02/19/2026
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