Healthcare Provider Details

I. General information

NPI: 1861317893
Provider Name (Legal Business Name): CHRISTINA JACKSON LPC-MHSP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E MAIN ST
MURFREESBORO TN
37130-3729
US

IV. Provider business mailing address

902 PALMER DR # A11
MURFREESBORO TN
37130-2644
US

V. Phone/Fax

Practice location:
  • Phone: 615-383-2115
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8879
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: