Provider Demographics
NPI:1336313881
Name:JACKSON MOORE, DELILAH J (LICENSED COUNSELOR)
Entity Type:Individual
Prefix:DR
First Name:DELILAH
Middle Name:J
Last Name:JACKSON MOORE
Suffix:
Gender:F
Credentials:LICENSED COUNSELOR
Other - Prefix:MRS
Other - First Name:DELILAH
Other - Middle Name:J
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICENSED COUNSELOR
Mailing Address - Street 1:5202 KEELE ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39206-4355
Mailing Address - Country:US
Mailing Address - Phone:601-982-8624
Mailing Address - Fax:601-982-8624
Practice Address - Street 1:5202 KEELE ST
Practice Address - Street 2:SUITE 1
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39206-4355
Practice Address - Country:US
Practice Address - Phone:601-982-8624
Practice Address - Fax:601-982-8624
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS00281101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health