Provider Demographics
NPI:1326624032
Name:JACKSON, CHARITY WEAVER (LGPC, NCACII)
Entity Type:Individual
Prefix:MRS
First Name:CHARITY
Middle Name:WEAVER
Last Name:JACKSON
Suffix:
Gender:F
Credentials:LGPC, NCACII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4822 41ST ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016-1708
Mailing Address - Country:US
Mailing Address - Phone:252-646-6860
Mailing Address - Fax:
Practice Address - Street 1:2112 F ST NW STE 102
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-2722
Practice Address - Country:US
Practice Address - Phone:202-349-3212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-23
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC1407101YA0400X
DCLGPC00618101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)