Provider Demographics
NPI:1851596928
Name:JACKSON, JOLITA (LPCS, L CAS, CCS)
Entity Type:Individual
Prefix:MRS
First Name:JOLITA
Middle Name:
Last Name:JACKSON
Suffix:
Gender:F
Credentials:LPCS, L CAS, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 E MAIN ST STE 5
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:NC
Mailing Address - Zip Code:28734-3059
Mailing Address - Country:US
Mailing Address - Phone:828-524-6390
Mailing Address - Fax:
Practice Address - Street 1:33 E MAIN ST STE 5
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:NC
Practice Address - Zip Code:28734-3059
Practice Address - Country:US
Practice Address - Phone:828-524-6390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3199101Y00000X
101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102469Medicaid