Provider Demographics
NPI:1942748819
Name:OLIVER-JACKSON, TAMARA (EDS, LPC, CAMS-II)
Entity Type:Individual
Prefix:MS
First Name:TAMARA
Middle Name:
Last Name:OLIVER-JACKSON
Suffix:
Gender:F
Credentials:EDS, LPC, CAMS-II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 WAVERLY TER
Mailing Address - Street 2:
Mailing Address - City:BESSEMER
Mailing Address - State:AL
Mailing Address - Zip Code:35020-6045
Mailing Address - Country:US
Mailing Address - Phone:205-475-1147
Mailing Address - Fax:
Practice Address - Street 1:424 WAVERLY TER
Practice Address - Street 2:
Practice Address - City:BESSEMER
Practice Address - State:AL
Practice Address - Zip Code:35020-6045
Practice Address - Country:US
Practice Address - Phone:205-475-1147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-10
Last Update Date:2017-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3677101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional