Provider Demographics
NPI:1902481773
Name:JACKSON, JULIANNE GRIFFIN (LPC)
Entity Type:Individual
Prefix:MRS
First Name:JULIANNE
Middle Name:GRIFFIN
Last Name:JACKSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:JULIANNE
Other - Middle Name:
Other - Last Name:GRIFFIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:335 BRAWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-1535
Mailing Address - Country:US
Mailing Address - Phone:251-610-6044
Mailing Address - Fax:
Practice Address - Street 1:3168 MIDTOWN PARK S STE E
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36606-4123
Practice Address - Country:US
Practice Address - Phone:251-216-9653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-13
Last Update Date:2021-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4066101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional