Provider Demographics
NPI:1831995190
Name:JACKSON, JAMIE LYNN (LPC)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:LYNN
Last Name:JACKSON
Suffix:
Gender:
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 284
Mailing Address - Street 2:
Mailing Address - City:CRIMORA
Mailing Address - State:VA
Mailing Address - Zip Code:24431-0284
Mailing Address - Country:US
Mailing Address - Phone:540-324-8787
Mailing Address - Fax:
Practice Address - Street 1:65 LADY SLIPPER DR
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:VA
Practice Address - Zip Code:22980-8374
Practice Address - Country:US
Practice Address - Phone:304-815-4979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-19
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701014750101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional