Provider Demographics
NPI:1447754205
Name:JACKSON, JOCELYN L (BCBA)
Entity Type:Individual
Prefix:
First Name:JOCELYN
Middle Name:L
Last Name:JACKSON
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11539 PARK WOODS CIR STE 502
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-2413
Mailing Address - Country:US
Mailing Address - Phone:678-527-3224
Mailing Address - Fax:678-366-5886
Practice Address - Street 1:11539 PARK WOODS CIR STE 502
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-2413
Practice Address - Country:US
Practice Address - Phone:678-527-3224
Practice Address - Fax:678-366-5886
Is Sole Proprietor?:No
Enumeration Date:2018-03-19
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst