Provider Demographics
NPI:1235339565
Name:JACKSON, TROYA LUSAND (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:TROYA
Middle Name:LUSAND
Last Name:JACKSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 W PEACHTREE ST NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-3608
Mailing Address - Country:US
Mailing Address - Phone:404-853-2800
Mailing Address - Fax:404-872-1636
Practice Address - Street 1:1105 W PEACHTREE ST NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-3608
Practice Address - Country:US
Practice Address - Phone:404-853-2800
Practice Address - Fax:404-872-1636
Is Sole Proprietor?:No
Enumeration Date:2007-07-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW003823104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker