Provider Demographics
NPI:1932311362
Name:JACKSON, YOLANDA DENEEN (CAREPROVIDER)
Entity Type:Individual
Prefix:MISS
First Name:YOLANDA
Middle Name:DENEEN
Last Name:JACKSON
Suffix:
Gender:F
Credentials:CAREPROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1214 WHISPERING PINES RD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31707-3562
Mailing Address - Country:US
Mailing Address - Phone:229-889-8287
Mailing Address - Fax:
Practice Address - Street 1:1214 WHISPERING PINES RD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707-3562
Practice Address - Country:US
Practice Address - Phone:229-889-8287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities