Provider Demographics
NPI:1699925610
Name:JACKSON, CAREN MARIE (MS/EDS, NCC, LPC)
Entity type:Individual
Prefix:
First Name:CAREN
Middle Name:MARIE
Last Name:JACKSON
Suffix:
Gender:F
Credentials:MS/EDS, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 PRESTWOULD DR
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27023-9523
Mailing Address - Country:US
Mailing Address - Phone:336-488-7465
Mailing Address - Fax:
Practice Address - Street 1:101 PRESTWOULD DR
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:NC
Practice Address - Zip Code:27023-9523
Practice Address - Country:US
Practice Address - Phone:336-488-7465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-26
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NC7148101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health