Provider Demographics
NPI:1760115034
Name:JACKSON, TOMEKA BENNETT (LPC 7281)
Entity Type:Individual
Prefix:
First Name:TOMEKA
Middle Name:BENNETT
Last Name:JACKSON
Suffix:
Gender:F
Credentials:LPC 7281
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 PINEHURST DR
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70131-3354
Mailing Address - Country:US
Mailing Address - Phone:504-444-1165
Mailing Address - Fax:
Practice Address - Street 1:73 PINEHURST DR
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70131-3354
Practice Address - Country:US
Practice Address - Phone:504-444-1165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-05
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7281101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty