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General NPI Number Information
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NPI Number | 1568037190
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Entity Type | Organization
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Legal Business Name | MINDY R. JACKSON, LPC
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Dates
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Enumeration Date | 05/25/2021
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Last Update Date | 12/28/2025
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Provider Practice Location Address
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Address Line | 1901 S MAIN ST STE 4A
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City | BLACKSBURG
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State | VA
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Zip | 24060-6628
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Country | US
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Telephone | 540-820-4242
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Fax |
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Provider Business Mailing Address
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Address Line | 1901 S MAIN ST STE 4A
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City | BLACKSBURG
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State | VA
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Zip | 24060-6628
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Country | US
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Telephone | 540-820-4242
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Fax |
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Authorized Official
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Title or Position | OWNER/MEMBER
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Name | MINNA R JACKSON
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Credential | LPC
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Telephone | 540-820-4242
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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 |
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License Number State |
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