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General NPI Number Information
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NPI Number | 1265144000
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Entity Type | Individual
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Provider Name | KATHERINE JACKSON MA, LMFTA
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Gender | Female
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Dates
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Enumeration Date | 12/22/2022
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Last Update Date | 12/22/2022
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Provider Practice Location Address
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Address Line | 6604 SIX FORKS RD
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City | RALEIGH
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State | NC
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Zip | 27615-6521
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Country | US
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Telephone | 919-725-8086
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Fax |
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Provider Business Mailing Address
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Address Line | 10204 RIVER BANK DR
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City | RALEIGH
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State | NC
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Zip | 27614-8928
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Country | US
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Telephone | 919-332-1517
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 12495A
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License Number State | NC
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