Provider Demographics
NPI:1295199636
Name:JACKSON, CURTIS D (LSW, LCDCIII)
Entity Type:Individual
Prefix:
First Name:CURTIS
Middle Name:D
Last Name:JACKSON
Suffix:
Gender:M
Credentials:LSW, LCDCIII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13377 SMITH RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-7810
Mailing Address - Country:US
Mailing Address - Phone:440-340-5558
Mailing Address - Fax:
Practice Address - Street 1:13377 SMITH RD
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-7810
Practice Address - Country:US
Practice Address - Phone:440-340-5558
Practice Address - Fax:440-340-5575
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-12
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS 1002048104100000X
OH021097101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker