| Provider / Organization | NPI | Date Certified |
|---|---|---|
| ANGELA JACKSON | 1194314732 | 2021-01-17 |
Angela Jackson is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1194314732. Registration indicates Angela Jackson is a provider of access to mental health/behavioral health providers services with a specialization in Behavioral Health & Social Service Providers, Behavioral Analyst (Behavioral Health & Social Service Providers, Behavioral Analyst) (Behavioral Analyst, ) (Behavioral Health/Substance Abuse/Psychiatry, ) (Behavioral Analyst, Behavioral Health & Social Service Providers)
| Entity Type | Individual |
| Provider Name | Angela Jackson |
| Practice Office Address | 1607 BRADMERE LN LITHIA SPRINGS, GA US |
| Practice Office Telephone | 6787612770 |
| Mailing Address | 1607 BRADMERE LN LITHIA SPRINGS, GA 301223253 US |
| Business Telephone | 6787612770 |
| Code | Practice | License No State |
|---|---|---|
| 103K00000X PRIMARY | Access to Mental Health/Behavioral Health Providers Behavioral Health & Social Service Providers Behavioral Analyst Behavioral Health & Social Service Providers Behavioral Analyst Behavioral Analyst Behavioral Health/Substance Abuse/Psychiatry Behavioral Analyst Behavioral Health & Social Service Providers | 2020-12959
GA |