Provider Demographics
NPI:1124654223
Name:JACKSON, RASHANDA CAPRICE (MSW, LCSWA)
Entity type:Individual
Prefix:
First Name:RASHANDA
Middle Name:CAPRICE
Last Name:JACKSON
Suffix:
Gender:F
Credentials:MSW, LCSWA
Other - Prefix:
Other - First Name:RASHANDA
Other - Middle Name:CAPRICE
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RASHANDA JACKSON
Mailing Address - Street 1:5840 CHASON RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-4847
Mailing Address - Country:US
Mailing Address - Phone:910-354-7263
Mailing Address - Fax:
Practice Address - Street 1:45 COMM PARK LN
Practice Address - Street 2:
Practice Address - City:ANGIER
Practice Address - State:NC
Practice Address - Zip Code:27501-5490
Practice Address - Country:US
Practice Address - Phone:910-502-3388
Practice Address - Fax:919-827-8500
Is Sole Proprietor?:No
Enumeration Date:2020-03-20
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0142461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical