Provider Demographics
NPI:1962862953
Name:DR. JACKIE JIANG COUNSELING & EVALUATION, LLC
Entity Type:Organization
Organization Name:DR. JACKIE JIANG COUNSELING & EVALUATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ZHUJUN
Authorized Official - Middle Name:
Authorized Official - Last Name:JIANG
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:309-221-7659
Mailing Address - Street 1:3816 27TH ST
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-6343
Mailing Address - Country:US
Mailing Address - Phone:309-944-7833
Mailing Address - Fax:309-403-0554
Practice Address - Street 1:3816 27TH ST
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-6343
Practice Address - Country:US
Practice Address - Phone:309-944-7833
Practice Address - Fax:309-403-0554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-03
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180007661101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1598954588OtherNPI OF THE CLINICIAN