Provider Demographics
NPI:1356471908
Name:JACKSON, VALERIE F (LMSW, ACSW)
Entity Type:Individual
Prefix:MS
First Name:VALERIE
Middle Name:F
Last Name:JACKSON
Suffix:
Gender:F
Credentials:LMSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5418 BRIGHT CREEK CT
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-2254
Mailing Address - Country:US
Mailing Address - Phone:810-845-6465
Mailing Address - Fax:810-733-7317
Practice Address - Street 1:G3163 FLUSHING RD
Practice Address - Street 2:SUITE 214
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48504-4365
Practice Address - Country:US
Practice Address - Phone:810-845-6465
Practice Address - Fax:810-733-7317
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801077180104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI8008976850OtherBC BS PIN