Provider Demographics
NPI:1780270058
Name:JACKSON, ESSENCE (LCSW, LISW-CP)
Entity type:Individual
Prefix:
First Name:ESSENCE
Middle Name:
Last Name:JACKSON
Suffix:
Gender:F
Credentials:LCSW, LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:785H KING GEORGE BLVD STE D-1021
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31419-9551
Mailing Address - Country:US
Mailing Address - Phone:912-500-2533
Mailing Address - Fax:
Practice Address - Street 1:785H KING GEORGE BLVD STE D-1021
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31419-9551
Practice Address - Country:US
Practice Address - Phone:912-500-2533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-21
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty