Provider Demographics
NPI:1447600770
Name:JACKSON, KRISTINA (CLC, MSLC)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:JACKSON
Suffix:
Gender:F
Credentials:CLC, MSLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5160 DOGWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:EIGHT MILE
Mailing Address - State:AL
Mailing Address - Zip Code:36613-8505
Mailing Address - Country:US
Mailing Address - Phone:205-267-3100
Mailing Address - Fax:
Practice Address - Street 1:5160 DOGWOOD TRL
Practice Address - Street 2:
Practice Address - City:EIGHT MILE
Practice Address - State:AL
Practice Address - Zip Code:36613-8505
Practice Address - Country:US
Practice Address - Phone:205-267-3100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-17
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral