Provider Demographics
NPI:1245218494
Name:JACKSON, JAMES LLOYD JR (LPC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:LLOYD
Last Name:JACKSON
Suffix:JR
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 CALMONT WOODS DR
Mailing Address - Street 2:
Mailing Address - City:MONTEVALLO
Mailing Address - State:AL
Mailing Address - Zip Code:35115-4348
Mailing Address - Country:US
Mailing Address - Phone:205-800-0215
Mailing Address - Fax:
Practice Address - Street 1:66 CALMONT WOODS DR
Practice Address - Street 2:
Practice Address - City:MONTEVALLO
Practice Address - State:AL
Practice Address - Zip Code:35115-4348
Practice Address - Country:US
Practice Address - Phone:205-800-0215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-06
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2405101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health