Janissa D Jackson Phd

LBN: Janissa D Jackson Phd Pllc
Janissa D Jackson Phd is an health care organization with primary practice located at 1 W Sunbridge Dr , Fayetteville AR 72703-1825. The organization recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Clinical, Behavioral Health & Social Service Providers / Clinical Child & Adolescent. Behavioral Health & Social Service Providers / Clinical Child & Adolescent is the primary health care specialty. Janissa D Jackson Phd Pllc can be contacted via phone (479) 443-5575, or through Latta, Lavonna via phone (479) 443-5575.

Contact Information

Primary practice address
1 W Sunbridge Dr Fayetteville AR 72703-1825
Phone: (479) 443-5575
Fax: (479) 443-9554
Website:
Map and Directions
Authorized official contact:
Name: Latta, Lavonna
Phone: (479) 443-5575

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 103TC0700X 07-01P Arkansas
Behavioral Health & Social Service Providers / Clinical Child & Adolescent 103TC2200X 07-01P Arkansas

Profile Details

NPI number 1871762476
LBN Legal business name Janissa D Jackson Phd Pllc
DBA Doing business as Janissa D Jackson Phd
Authorized official Latta, Lavonna
Entity Organization
Organization subpart 1 No
Enumeration date Feb 27th, 2008
Last updated Feb 27th, 2008 - about 17 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1871762476 NPPES
Arkansas Other 5A252 BLUECROSS BLUESHIELD

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