Provider Demographics
NPI:1295369197
Name:EVANS-JACKSON, AARON (LCSW CSW007073)
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:
Last Name:EVANS-JACKSON
Suffix:
Gender:M
Credentials:LCSW CSW007073
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:931 MONROE DR NE STE A102
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-2183
Mailing Address - Country:US
Mailing Address - Phone:404-907-1934
Mailing Address - Fax:
Practice Address - Street 1:2751 BUFORD HWY NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324-3207
Practice Address - Country:US
Practice Address - Phone:404-907-1934
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-28
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0070731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical