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General NPI Number Information
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NPI Number | 1215648282
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Entity Type | Individual
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Provider Name | CARNETHA MEION JACKSON
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Gender | Female
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Dates
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Enumeration Date | 12/09/2022
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Last Update Date | 12/02/2025
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Provider Practice Location Address
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Address Line | 3901 MCCAIN PARK DR STE 102
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City | NORTH LITTLE ROCK
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State | AR
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Zip | 72116-7849
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Country | US
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Telephone | 501-744-7421
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Fax |
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Provider Business Mailing Address
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Address Line | 3901 MCCAIN PARK DR STE 102
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City | NORTH LITTLE ROCK
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State | AR
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Zip | 72116-7849
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Country | US
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Telephone | 501-744-7421
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | A2411010
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License Number State | AR
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