Provider Demographics
NPI:1013530831
Name:JACKSON, LARI MEEKER (PSYD)
Entity Type:Individual
Prefix:
First Name:LARI
Middle Name:MEEKER
Last Name:JACKSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4030 WAKE FOREST RD STE 349
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-0010
Mailing Address - Country:US
Mailing Address - Phone:984-214-8762
Mailing Address - Fax:
Practice Address - Street 1:832 LAUREL GARDEN WAY
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-2046
Practice Address - Country:US
Practice Address - Phone:984-214-8762
Practice Address - Fax:984-220-9379
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-27
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3443103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical