Provider Demographics
NPI:1902141427
Name:JACKSON, NELL T (MA, LPC)
Entity type:Individual
Prefix:
First Name:NELL
Middle Name:T
Last Name:JACKSON
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 OLCOTT SQ
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BERNARDSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07924-2306
Mailing Address - Country:US
Mailing Address - Phone:908-953-9200
Mailing Address - Fax:908-953-9220
Practice Address - Street 1:29 OLCOTT SQ
Practice Address - Street 2:SUITE 2
Practice Address - City:BERNARDSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07924-2306
Practice Address - Country:US
Practice Address - Phone:908-953-9200
Practice Address - Fax:908-953-9220
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-10
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00090600101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional