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General NPI Number Information
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NPI Number | 1962733816
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Entity Type | Individual
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Provider Name | ROLANDA YVETTE JACKSON
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Gender | Female
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Dates
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Enumeration Date | 01/15/2010
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Last Update Date | 04/17/2026
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Provider Practice Location Address
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Address Line | 2002 HOLCOMBE BLVD
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City | HOUSTON
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State | TX
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Zip | 77030-4211
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Country | US
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Telephone | 713-794-1414
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Fax |
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Provider Business Mailing Address
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Address Line | 1326 GLENDORA DR
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City | ROSHARON
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State | TX
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Zip | 77583-4495
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Country | US
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Telephone | 360-688-4759
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW798
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License Number State | WY
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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 | 111313
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License Number State | TX
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