Provider Demographics
NPI:1679036073
Name:JACKSON, AKKIE NATOYA
Entity Type:Individual
Prefix:
First Name:AKKIE
Middle Name:NATOYA
Last Name:JACKSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39B SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854-5918
Mailing Address - Country:US
Mailing Address - Phone:732-720-3631
Mailing Address - Fax:
Practice Address - Street 1:39B SCHOOL ST
Practice Address - Street 2:
Practice Address - City:PISCATAWAY
Practice Address - State:NJ
Practice Address - Zip Code:08854-5918
Practice Address - Country:US
Practice Address - Phone:732-720-3631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-11
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ022578OtherABA4U