Provider Demographics
NPI:1063937407
Name:OLIVER JACKSON & ASSOCIATES LLC
Entity type:Organization
Organization Name:OLIVER JACKSON & ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:RENAYE
Authorized Official - Last Name:OLIVER-JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:EDS, LPC, CAMS-II
Authorized Official - Phone:205-881-6405
Mailing Address - Street 1:424 WAVERLY TER
Mailing Address - Street 2:
Mailing Address - City:BESSEMER
Mailing Address - State:AL
Mailing Address - Zip Code:35020-6045
Mailing Address - Country:US
Mailing Address - Phone:205-881-6405
Mailing Address - Fax:205-449-4400
Practice Address - Street 1:401 19TH ST N STE 106
Practice Address - Street 2:
Practice Address - City:BESSEMER
Practice Address - State:AL
Practice Address - Zip Code:35020-4817
Practice Address - Country:US
Practice Address - Phone:205-881-6405
Practice Address - Fax:205-449-4400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty