Provider Demographics
NPI:1083825897
Name:JACKSON, CHRISTINA (MS)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:JACKSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:
Other - Last Name:PARSONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4420 ROSEMAR CTR STE 201C
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26104-1255
Mailing Address - Country:US
Mailing Address - Phone:304-220-0041
Mailing Address - Fax:304-220-0112
Practice Address - Street 1:4420 ROSEMAR CTR STE 201C
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26104-1255
Practice Address - Country:US
Practice Address - Phone:304-220-0041
Practice Address - Fax:304-220-0112
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2147101YP2500X
WV1232103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional