Provider Demographics
NPI:1871834267
Name:JACKSON, SHERIKA MARCHELLE (LCSW, LCASA)
Entity Type:Individual
Prefix:MISS
First Name:SHERIKA
Middle Name:MARCHELLE
Last Name:JACKSON
Suffix:
Gender:F
Credentials:LCSW, LCASA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1048 WARPERS LN
Mailing Address - Street 2:STE 207
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29715-2087
Mailing Address - Country:US
Mailing Address - Phone:704-612-0566
Mailing Address - Fax:704-498-4846
Practice Address - Street 1:314 E THOMAS RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-3202
Practice Address - Country:US
Practice Address - Phone:480-853-5514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-08
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0091541041C0700X
AZLCSW-211421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP007636OtherLCSWA NUMBER