Provider Demographics
NPI:1538737929
Name:JACKSON, EILEEN MARIE (CADC, CPSS, BS)
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:MARIE
Last Name:JACKSON
Suffix:
Gender:F
Credentials:CADC, CPSS, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 ROBERTS RD STE 103
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-6631
Mailing Address - Country:US
Mailing Address - Phone:828-505-3086
Mailing Address - Fax:828-274-6377
Practice Address - Street 1:6 ROBERTS RD STE 103
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-6631
Practice Address - Country:US
Practice Address - Phone:828-778-1006
Practice Address - Fax:828-274-6377
Is Sole Proprietor?:No
Enumeration Date:2021-06-14
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCADC-22817101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)