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General NPI Number Information
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NPI Number | 1902141427
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Entity Type | Individual
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Provider Name | NELL T JACKSON M.A., L.P.C.
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Gender | Female
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Dates
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Enumeration Date | 12/10/2012
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Last Update Date | 12/10/2012
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Provider Practice Location Address
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Address Line | 29 OLCOTT SQ SUITE 2
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City | BERNARDSVILLE
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State | NJ
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Zip | 07924-2306
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Country | US
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Telephone | 908-953-9200
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Fax | 908-953-9220
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Provider Business Mailing Address
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Address Line | 29 OLCOTT SQ SUITE 2
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City | BERNARDSVILLE
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State | NJ
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Zip | 07924-2306
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Country | US
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Telephone | 908-953-9200
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Fax | 908-953-9220
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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 | 37PC00090600
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License Number State | NJ
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