Provider Demographics
NPI:1790081511
Name:JACKSON, DON BENARD JR (BA)
Entity Type:Individual
Prefix:MR
First Name:DON
Middle Name:BENARD
Last Name:JACKSON
Suffix:JR
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2026 DETROIT ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32254-1937
Mailing Address - Country:US
Mailing Address - Phone:919-539-7362
Mailing Address - Fax:
Practice Address - Street 1:1650 ART MUSEUM DR
Practice Address - Street 2:SUITE 11
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-1118
Practice Address - Country:US
Practice Address - Phone:904-881-8235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-27
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health