Jackson, Shatara
Jackson, Shatara is an sole proprietor health care provider with primary practice located at 5 Mall Anx , Savannah GA 31406-4738. She recently has 5 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), Behavioral Health & Social Service Providers / Mental Health, Behavioral Health & Social Service Providers / Clinical, Ambulatory Health Care Facilities / Adult Mental Health, Ambulatory Health Care Facilities / Adolescent and Children Mental Health. Behavioral Health & Social Service Providers / Clinical is her primary health care specialty. Jackson, Shatara can be contacted via phone (912) 495-8887.Contact Information
Primary practice address
5 Mall Anx
Savannah GA 31406-4738
Phone: (912) 495-8887
Fax: (912) 495-8881
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) | 101YA0400X | ||
| Behavioral Health & Social Service Providers / Mental Health | 101YM0800X | ||
| Behavioral Health & Social Service Providers / Clinical | 1041C0700X | 15612 | South Carolina |
| Ambulatory Health Care Facilities / Adult Mental Health | 261QM0850X | ||
| Ambulatory Health Care Facilities / Adolescent and Children Mental Health | 261QM0855X | ||
| Behavioral Health & Social Service Providers / Clinical | 1041C0700X | CSW008276 | Georgia |
Profile Details
| NPI number | 1033660949 |
|---|---|
| LBN Legal business name | Jackson, Shatara |
| Credentials | Licensed Clinical Social Worker (LCSW) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Oct 17th, 2016 |
| Last updated | Apr 6th, 2023 - about 3 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1033660949 | NPPES |
| Massachusetts | MEDICAID | 110026265E |
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