Jackson, Mary Y

Jackson, Mary Y is an sole proprietor health care provider with primary practice located at 1804 Martin Luther King Jr. Parkway Suite 210, Durham NC 27707-2933. She recently has only one registered license in Behavioral Health & Social Service Providers / Professional, which is considered as her primary health care specialty. Jackson, Mary Y can be contacted via phone (919) 489-2254.

Contact Information

Primary practice address
1804 Martin Luther King Jr. Parkway Suite 210 Durham NC 27707-2933
Phone: (919) 489-2254
Fax: (919) 403-1551
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Professional 101YP2500X C001005 North Carolina

Profile Details

NPI number 1629109665
LBN Legal business name Jackson, Mary Y
Credentials Licensed Clinical Social Worker (LCSW)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Mar 9th, 2007
Last updated Jul 8th, 2007 - about 17 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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Identifiers

StateTypeNumberIssuer
All States NPI 1629109665 NPPES
North Carolina MEDICAID 6106541

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