Provider Demographics
NPI:1558870774
Name:JACKSON, MEGHAN T (LPC)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:T
Last Name:JACKSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 NEW BRITAIN AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06110-2447
Mailing Address - Country:US
Mailing Address - Phone:860-970-8639
Mailing Address - Fax:860-970-8639
Practice Address - Street 1:1100 NEW BRITAIN AVE STE 201
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06110-2447
Practice Address - Country:US
Practice Address - Phone:860-970-8639
Practice Address - Fax:860-970-8639
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003175101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional