Healthcare Provider Details

I. General information

NPI: 1285200667
Provider Name (Legal Business Name): JOY KATHERINE JACKSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2021
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4273 CORPORATE WAY
MOUNT PLEASANT MI
48858-1082
US

IV. Provider business mailing address

4273 CORPORATE WAY
MOUNT PLEASANT MI
48858-1082
US

V. Phone/Fax

Practice location:
  • Phone: 989-953-4357
  • Fax:
Mailing address:
  • Phone: 989-953-4357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: