Ms Mary Theresa Jackson, LPC is a
Counselor - Professional based in Ellabell, Georgia. Ms Mary Theresa Jackson is licensed to practice in Georgia (license number LPC011711) and her current practice location is
345 Old Cuyler Rd, Ellabell, Georgia. She can be reached at her office (for appointments etc.) via phone at
(912) 320-3205.
NPI number for Ms Mary Theresa Jackson is 1699121129 and her current mailing address is 345 Old Cuyler Rd, Ellabell, Georgia. She
does not participate in medicare program and thus does not accept medicare assignments. Her NPI Number is 1699121129.
Healthcare Provider's Profile
| Full Name | Ms Mary Theresa Jackson |
|---|
| Gender | Female |
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| Speciality | Counselor - Professional |
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| Location | 345 Old Cuyler Rd, Ellabell, Georgia |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. She may not accept medicare assignment. |
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NPI Data:
- NPI Number: 1699121129
- Provider Enumeration Date: 05/13/2016
- Last Update Date: 11/27/2023
Medical Identifiers
Medical identifiers for Ms Mary Theresa Jackson such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1699121129 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Secondary |
| 101YP2500X | Counselor - Professional | LPC011711 (Georgia) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Ms Mary Theresa Jackson is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Ms Mary Theresa Jackson, LPC
345 Old Cuyler Rd,
Ellabell, GA 31308-5858
Ph: (912) 320-3205 | Ms Mary Theresa Jackson, LPC
345 Old Cuyler Rd,
Ellabell, GA 31308-5858
Ph: (912) 320-3205 |
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