Provider Demographics
NPI:1821145525
Name:JACKSON, CHRISTOPHER S (LCSW)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:S
Last Name:JACKSON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 COMMERCE DRIVE
Mailing Address - Street 2:
Mailing Address - City:SKOWHEGAN
Mailing Address - State:ME
Mailing Address - Zip Code:04976
Mailing Address - Country:US
Mailing Address - Phone:207-474-8311
Mailing Address - Fax:207-474-5148
Practice Address - Street 1:72 WINTHROP STREET
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330
Practice Address - Country:US
Practice Address - Phone:207-626-3478
Practice Address - Fax:207-626-7586
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC87381041C0700X
MELC114601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical