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General NPI Number Information
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NPI Number | 1871834267
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Entity Type | Individual
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Provider Name | SHERIKA MARCHELLE JACKSON LCSW, LCASA
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Gender | Female
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Dates
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Enumeration Date | 03/08/2013
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Last Update Date | 08/31/2023
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Provider Practice Location Address
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Address Line | 314 E THOMAS RD
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City | PHOENIX
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State | AZ
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Zip | 85012-3202
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Country | US
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Telephone | 480-853-5514
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Fax |
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Provider Business Mailing Address
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Address Line | 1048 WARPERS LN STE 207
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City | FORT MILL
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State | SC
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Zip | 29715-2087
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Country | US
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Telephone | 704-612-0566
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Fax | 704-498-4846
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | C009154
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW-21142
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License Number State | AZ
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