Provider Demographics
NPI:1598091605
Name:JACKSON, LEON C (LCSW-BACS)
Entity Type:Individual
Prefix:
First Name:LEON
Middle Name:C
Last Name:JACKSON
Suffix:
Gender:M
Credentials:LCSW-BACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5901 BACCICH ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70122-6411
Mailing Address - Country:US
Mailing Address - Phone:504-417-2274
Mailing Address - Fax:
Practice Address - Street 1:5200 LAPALCO BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-4254
Practice Address - Country:US
Practice Address - Phone:504-417-2274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-23
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical