Provider Demographics
NPI:1689435877
Name:JACKSON, EVLYN ELIZABETH (LCSWA)
Entity Type:Individual
Prefix:
First Name:EVLYN
Middle Name:ELIZABETH
Last Name:JACKSON
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 PEARSON DR
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-1646
Mailing Address - Country:US
Mailing Address - Phone:858-699-6102
Mailing Address - Fax:
Practice Address - Street 1:223 E CHESTNUT ST STE 4
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-2480
Practice Address - Country:US
Practice Address - Phone:828-400-6299
Practice Address - Fax:828-372-4701
Is Sole Proprietor?:No
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0192051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical