Provider Demographics
NPI:1134374846
Name:JACKSON, CHARITY FINCH (MS, LPC, BCN)
Entity type:Individual
Prefix:
First Name:CHARITY
Middle Name:FINCH
Last Name:JACKSON
Suffix:
Gender:F
Credentials:MS, LPC, BCN
Other - Prefix:
Other - First Name:CHARITY
Other - Middle Name:
Other - Last Name:FINCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LPC, BCN
Mailing Address - Street 1:1335 PASEO DEL PUEBLO SUR # 249
Mailing Address - Street 2:
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-5972
Mailing Address - Country:US
Mailing Address - Phone:940-220-1684
Mailing Address - Fax:
Practice Address - Street 1:412 S CARROLL BLVD
Practice Address - Street 2:SUITE 2001
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-7449
Practice Address - Country:US
Practice Address - Phone:940-220-1684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-21
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
73299101YP2500X
NMCTB-2023-0017101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional