Provider Demographics
NPI:1093065484
Name:JACKSON-PRICE, HIZA BENITA MARIA (MA, LPC, LCAS)
Entity Type:Individual
Prefix:
First Name:HIZA
Middle Name:BENITA MARIA
Last Name:JACKSON-PRICE
Suffix:
Gender:F
Credentials:MA, LPC, LCAS
Other - Prefix:
Other - First Name:HIZA
Other - Middle Name:BENITA MARIA
Other - Last Name:JACKSON-PRICE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, LPC, LCAS
Mailing Address - Street 1:455 E JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001-4724
Mailing Address - Country:US
Mailing Address - Phone:910-265-1235
Mailing Address - Fax:
Practice Address - Street 1:115 SEAWARD DR
Practice Address - Street 2:
Practice Address - City:HOLLY RIDGE
Practice Address - State:NC
Practice Address - Zip Code:28445-7998
Practice Address - Country:US
Practice Address - Phone:910-265-1235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-13
Last Update Date:2019-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2368101YA0400X
NC7680101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1093065484OtherNATIONAL PROVIDER IDENTIFIER ENUMERATOR