Provider Demographics
NPI:1922482843
Name:JACKSON, TONJA (LCSW-BACS)
Entity Type:Individual
Prefix:
First Name:TONJA
Middle Name:
Last Name:JACKSON
Suffix:
Gender:F
Credentials:LCSW-BACS
Other - Prefix:
Other - First Name:TONJA
Other - Middle Name:
Other - Last Name:CHOPFIELD-JACKSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW-BACS
Mailing Address - Street 1:3204 OAK DR
Mailing Address - Street 2:
Mailing Address - City:VIOLET
Mailing Address - State:LA
Mailing Address - Zip Code:70092-3734
Mailing Address - Country:US
Mailing Address - Phone:504-261-5211
Mailing Address - Fax:
Practice Address - Street 1:908 W JUDGE PEREZ DR
Practice Address - Street 2:SUITE D
Practice Address - City:CHALMETTE
Practice Address - State:LA
Practice Address - Zip Code:70043-4773
Practice Address - Country:US
Practice Address - Phone:504-453-7698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-10
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA44871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical