Provider Demographics
NPI:1134956055
Name:JACKSON PSYCHOLOGICAL ASSESSMENT AND THERAPEUTIC SERVICES
Entity type:Organization
Organization Name:JACKSON PSYCHOLOGICAL ASSESSMENT AND THERAPEUTIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON-WESTBROOK
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:919-877-6879
Mailing Address - Street 1:150 PROVIDENCE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-2208
Mailing Address - Country:US
Mailing Address - Phone:919-877-6879
Mailing Address - Fax:
Practice Address - Street 1:150 PROVIDENCE RD STE 101
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-2208
Practice Address - Country:US
Practice Address - Phone:919-877-6879
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty