Provider Demographics
NPI:1942577200
Name:JACKSON, DONALD JEFFERSON (MSW LCSW LCAS-A)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:JEFFERSON
Last Name:JACKSON
Suffix:
Gender:M
Credentials:MSW LCSW LCAS-A
Other - Prefix:MR
Other - First Name:JEFF
Other - Middle Name:
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:434 ATKINSON ST
Mailing Address - Street 2:
Mailing Address - City:LAURINBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28352-3714
Mailing Address - Country:US
Mailing Address - Phone:910-506-2008
Mailing Address - Fax:910-506-2010
Practice Address - Street 1:434 ATKINSON ST
Practice Address - Street 2:
Practice Address - City:LAURINBURG
Practice Address - State:NC
Practice Address - Zip Code:28352-3714
Practice Address - Country:US
Practice Address - Phone:910-506-2008
Practice Address - Fax:910-506-2010
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-30
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0075381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical