Provider Demographics
NPI:1215310115
Name:JACKSON, DONALD LEE JR (LPC)
Entity type:Individual
Prefix:MR
First Name:DONALD
Middle Name:LEE
Last Name:JACKSON
Suffix:JR
Gender:
Credentials:LPC
Other - Prefix:MR
Other - First Name:LEE
Other - Middle Name:
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:PO BOX 235
Mailing Address - Street 2:
Mailing Address - City:STATHAM
Mailing Address - State:GA
Mailing Address - Zip Code:30666-0005
Mailing Address - Country:US
Mailing Address - Phone:706-705-2578
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 235
Practice Address - Street 2:
Practice Address - City:STATHAM
Practice Address - State:GA
Practice Address - Zip Code:30666-0005
Practice Address - Country:US
Practice Address - Phone:706-705-2578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-09
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC008592101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor