Jackson, Clinton Wayne
Jackson, Clinton Wayne is an individual health care provider with primary practice located at 6600 Van Aalst Blvd , Fort Moore GA 31905-2102. He recently has only one registered license in Behavioral Health & Social Service Providers / Social Worker, which is considered as his primary health care specialty. Jackson, Clinton Wayne can be contacted via phone (762) 408-4065.Contact Information
Primary practice address
6600 Van Aalst Blvd
Fort Moore GA 31905-2102
Phone: (762) 408-4065
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Social Worker | 104100000X | ||
| Behavioral Health & Social Service Providers / Social Worker | 104100000X | CSW004875 | Georgia |
Profile Details
| NPI number | 1346416955 |
|---|---|
| LBN Legal business name | Jackson, Clinton Wayne |
| Credentials | Licensed Clinical Social Worker (LCSW) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | May 3rd, 2008 |
| Last updated | Sep 22nd, 2023 - about 2 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
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