Provider Demographics
NPI:1790958460
Name:JACKSON COUNSELING AGENCY
Entity Type:Organization
Organization Name:JACKSON COUNSELING AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR AND OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:SR
Authorized Official - Credentials:LMSW LCSW
Authorized Official - Phone:734-913-9225
Mailing Address - Street 1:1900 W STADIUM BLVD
Mailing Address - Street 2:6&7
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-7008
Mailing Address - Country:US
Mailing Address - Phone:734-913-9225
Mailing Address - Fax:
Practice Address - Street 1:1900 W STADIUM BLVD
Practice Address - Street 2:6&7
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-7008
Practice Address - Country:US
Practice Address - Phone:734-913-9225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty