Provider Demographics
NPI:1649572025
Name:JACKSON, LINDA A (LMHC)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:A
Last Name:JACKSON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 LOWELL ST
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:MA
Mailing Address - Zip Code:01867-1523
Mailing Address - Country:US
Mailing Address - Phone:781-944-2168
Mailing Address - Fax:781-944-3135
Practice Address - Street 1:338 MAIN ST
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880-5042
Practice Address - Country:US
Practice Address - Phone:781-246-2003
Practice Address - Fax:781-245-6377
Is Sole Proprietor?:No
Enumeration Date:2010-11-17
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7522101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health