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General NPI Number Information
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NPI Number | 1629195466
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Entity Type | Individual
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Provider Name | ALICIA ALEXANDER JACKSON LCAS
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Gender | Female
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 05/25/2016
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Provider Practice Location Address
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Address Line | 2003 GODWIN AVE
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City | LUMBERTON
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State | NC
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Zip | 28358-3149
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Country | US
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Telephone | 910-671-1111
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Fax | 910-671-4454
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Provider Business Mailing Address
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Address Line | 570 POPE LAKE RD PO BOX 473
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City | ANGIER
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State | NC
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Zip | 27501-5877
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Country | US
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Telephone | 910-671-1111
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Fax | 910-671-4454
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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