person
Jerry Edwin Jackson JR., LPC
Professional Counselor in Wilmington, North Carolina
NPI 1356423594

Jerry Edwin Jackson JR. is a Professional Counselor based in Wilmington, NC and is specialized in Professional. Jerry Edwin Jackson JR. practices in Wilmington, NC and has the professional credentials of LPC. The NPI Number for Jerry Edwin Jackson JR. is 1356423594 and holds a License No. 5109 (North Carolina).

The current practice location address for Jerry Edwin Jackson JR. is 3963 Market Street, Wilmington, NC and can be reached out via phone at 910-362-9474 and via fax at 910-362-9192. You can also correspond with Jerry Edwin Jackson JR. through the mailing address at 3963 MARKET STREET, WILMINGTON, NC - 28403 (mailing address contact number: 910-362-9474).

Location: 3963 Market Street, Wilmington, NC, 28403
person
Provider Profile Details
NPI Number
1356423594
Provider Name
Jerry Edwin Jackson JR.
Credential
LPC
Provider Entity Type
Individual
Gender
Male
Address
3963 Market Street, Wilmington, NC, 28403
Phone Number
910-362-9474
Fax Number
910-362-9192
Provider Enumeration Date
10/19/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
6103285 05 NC
institution
Provider Business Practice Location Address Details
Address
3963 Market Street
City
State
Zip
28403
Phone Number
910-362-9474
Fax Number
910-362-9192
person
Provider Business Mailing Address Details
Address
3963 Market Street
City
State
Zip
28403
Phone Number
910-362-9474
Fax Number
910-362-9192
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Professional
Taxonomy
License No.
5109 (North Carolina)
Definition
Definition to come...
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