Provider Demographics
NPI:1467613570
Name:JACKSON, AESHIA L (MSW, PLCSW)
Entity Type:Individual
Prefix:MS
First Name:AESHIA
Middle Name:L
Last Name:JACKSON
Suffix:
Gender:F
Credentials:MSW, PLCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 PEAR ST
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:NC
Mailing Address - Zip Code:28315-2924
Mailing Address - Country:US
Mailing Address - Phone:910-992-3048
Mailing Address - Fax:910-944-2417
Practice Address - Street 1:100 PEAR ST
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:NC
Practice Address - Zip Code:28315-2924
Practice Address - Country:US
Practice Address - Phone:910-992-3048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-20
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0161531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical