Provider Demographics
NPI:1134008923
Name:JACKSON, SHALONDA MICHELLE (LMSW)
Entity type:Individual
Prefix:
First Name:SHALONDA
Middle Name:MICHELLE
Last Name:JACKSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 159
Mailing Address - Street 2:
Mailing Address - City:COLDSPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77331-0159
Mailing Address - Country:US
Mailing Address - Phone:936-714-7084
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 159
Practice Address - Street 2:
Practice Address - City:COLDSPRING
Practice Address - State:TX
Practice Address - Zip Code:77331-0159
Practice Address - Country:US
Practice Address - Phone:936-714-7084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-27
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113241104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker