Provider Demographics
NPI:1386269231
Name:JACKSON, RASHEEDA (MHS, CRS, CMA)
Entity type:Individual
Prefix:
First Name:RASHEEDA
Middle Name:
Last Name:JACKSON
Suffix:
Gender:F
Credentials:MHS, CRS, CMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 ROSEMAR ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19120-1922
Mailing Address - Country:US
Mailing Address - Phone:267-475-9881
Mailing Address - Fax:
Practice Address - Street 1:117 ROSEMAR ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19120-1922
Practice Address - Country:US
Practice Address - Phone:267-475-9881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-16
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty