| Elizabeth W Jackson Phd Pllc | |
|
122 Saint Marys St Raleigh NC 27605-1809 | |
| (919) 423-2293 | |
| Not Available |
| Full Name | Elizabeth W Jackson Phd Pllc |
|---|---|
| Speciality | Psychologist |
| Location | 122 Saint Marys St, Raleigh, North Carolina |
| Authorized Official Name and Position | Elizabeth Wood Jackson (OWNER) |
| Authorized Official Contact | 9194232293 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Elizabeth W Jackson Phd Pllc 122 Saint Marys St Raleigh NC 27605-1809 Ph: (919) 423-2293 | Elizabeth W Jackson Phd Pllc 122 Saint Marys St Raleigh NC 27605-1809 Ph: (919) 423-2293 |
| NPI Number | 1306199658 |
|---|---|
| Provider Enumeration Date | 10/24/2012 |
| Last Update Date | 09/11/2018 |
| Medicare PECOS PAC ID | 8224289392 |
|---|---|
| Medicare Enrollment ID | O20121119000615 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306199658 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Elizabeth W Jackson |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1477882272 PECOS PAC ID: 0042461113 Enrollment ID: I20121119000620 |
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