Provider Demographics
NPI:1992195036
Name:JACKSON, ERIKA (PLPC)
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:
Last Name:JACKSON
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 CHURCH ST
Mailing Address - Street 2:STE. 103
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63135-2441
Mailing Address - Country:US
Mailing Address - Phone:314-616-8919
Mailing Address - Fax:
Practice Address - Street 1:111 CHURCH ST
Practice Address - Street 2:STE. 103
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63135-2441
Practice Address - Country:US
Practice Address - Phone:314-616-8919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-28
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015000873101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor