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General NPI Number Information
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NPI Number | 1386317998
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Entity Type | Individual
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Provider Name | SHANBRIEL DASHAY JACKSON LPC
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Gender | Female
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Dates
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Enumeration Date | 07/29/2021
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Last Update Date | 03/13/2025
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Provider Practice Location Address
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Address Line | 610 UPTOWN BLVD FL 2
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City | CEDAR HILL
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State | TX
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Zip | 75104-3527
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Country | US
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Telephone | 844-824-8775
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Fax | 281-648-2200
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Provider Business Mailing Address
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Address Line | 1910 PACIFIC AVE SUITE 2000 PMB 1105
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City | DALLAS
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State | TX
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Zip | 75201-4540
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Country | US
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Telephone | 972-537-6971
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 82960
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License Number State | TX
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