person
Jalisa Jackson
Mental Illness Community Based Residential Treatment Facility in Charlotte, North Carolina
NPI 1366041667

Jalisa Jackson is a Mental Illness Community Based Residential Treatment Facility based in Charlotte, NC. Jalisa Jackson practices in Charlotte, NC. The NPI Number for Jalisa Jackson is 1366041667 and holds a License No. MHL-036-348 (North Carolina).

The current practice location address for Jalisa Jackson is 11413 Mangla Dr, Charlotte, NC and can be reached out via phone at 704-819-4909.

Location: 11413 Mangla Dr, Charlotte, NC, 28214-8885
person
Provider Profile Details
NPI Number
1366041667
Provider Name
Jalisa Jackson
Credential
Provider Entity Type
Individual
Gender
Female
Address
11413 Mangla Dr, Charlotte, NC, 28214-8885
Phone Number
704-819-4909
Fax Number
Provider Enumeration Date
10/19/2020
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
11413 Mangla Dr
City
State
Zip
28214-8885
Phone Number
704-819-4909
Fax Number
person
Provider Business Mailing Address Details
Address
11413 Mangla Dr
City
State
Zip
28214-8885
Phone Number
704-819-4909
Fax Number
person
Provider's Taxonomy Details 1
Type
Residential Treatment Facilities
Classification
Community Based Residential Treatment Facility, Mental Illness
Speciality
-
Taxonomy
License No.
MHL-036-348 (North Carolina)
Definition
A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness.
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