Provider Demographics
NPI:1225462997
Name:JACKSON, WILLA MARIE M (LPC; LPSC; CRC)
Entity Type:Individual
Prefix:MRS
First Name:WILLA MARIE
Middle Name:M
Last Name:JACKSON
Suffix:
Gender:F
Credentials:LPC; LPSC; CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 BRANDYWINE BLVD STE E
Mailing Address - Street 2:STE 3
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-7303
Mailing Address - Country:US
Mailing Address - Phone:740-297-7800
Mailing Address - Fax:740-297-7228
Practice Address - Street 1:1100 BRANDYWINE BLVD STE E
Practice Address - Street 2:STE 3
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-7303
Practice Address - Country:US
Practice Address - Phone:740-297-7800
Practice Address - Fax:740-297-7228
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-29
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1200315101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional