Provider Demographics
NPI:1619980091
Name:MILBOURNE-JACKSON, MARSHE MARIE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:MARSHE
Middle Name:MARIE
Last Name:MILBOURNE-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 1:3829 HEADWIND LN
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23703-5391
Mailing Address - Country:US
Mailing Address - Phone:757-686-3190
Mailing Address - Fax:
Practice Address - Street 1:2101 EXECUTIVE DR
Practice Address - Street 2:SUITE 5C, BOX19
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-2404
Practice Address - Country:US
Practice Address - Phone:757-827-7707
Practice Address - Fax:757-838-2573
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004014101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0701004014OtherLPC