Healthcare Provider Details

I. General information

NPI: 1306394234
Provider Name (Legal Business Name): JACKSON HANDS OF CHANGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2016
Last Update Date: 07/07/2023
Certification Date: 07/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4035 WASHINGTON AVE
NEW ORLEANS LA
70125-2935
US

IV. Provider business mailing address

4807 EVANGELINE ST
METAIRIE LA
70001-4415
US

V. Phone/Fax

Practice location:
  • Phone: 618-623-9771
  • Fax: 877-250-2283
Mailing address:
  • Phone: 618-623-9771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateLA

VIII. Authorized Official

Name: DREATHA JEAN JACKSON
Title or Position: CEO
Credential: LPS-S, NCC
Phone: 618-623-9771