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General NPI Number Information
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NPI Number | 1548750961
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Entity Type | Individual
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Provider Name | KARLA JACKSON LCMHC
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Gender | Female
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Dates
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Enumeration Date | 05/10/2018
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Last Update Date | 06/11/2025
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Provider Practice Location Address
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Address Line | 301 N ELM ST
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City | GREENSBORO
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State | NC
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Zip | 27401
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Country | US
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Telephone | 336-275-7973
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Fax |
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Provider Business Mailing Address
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Address Line | 301 N ELM ST
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City | GREENSBORO
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State | NC
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Zip | 27401-2083
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Country | US
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Telephone | 912-800-1496
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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 | APC005678
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | A13891
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 21517
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License Number State | NC
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