Provider Demographics
NPI:1316624414
Name:JACKSON GOODWINS, FELISA A (BSW, MAC, CCMA)
Entity type:Individual
Prefix:MRS
First Name:FELISA
Middle Name:A
Last Name:JACKSON GOODWINS
Suffix:
Gender:
Credentials:BSW, MAC, CCMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2198
Mailing Address - Street 2:
Mailing Address - City:SEMMES
Mailing Address - State:AL
Mailing Address - Zip Code:36575-2198
Mailing Address - Country:US
Mailing Address - Phone:251-776-2627
Mailing Address - Fax:
Practice Address - Street 1:100 US - 11
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:AL
Practice Address - Zip Code:35470
Practice Address - Country:US
Practice Address - Phone:251-776-2627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-29
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
ALT72125183700000X
AL6-000742163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No183700000XPharmacy Service ProvidersPharmacy Technician