Provider Demographics
NPI:1831664671
Name:JACKSON, ROBIN ANDREA (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:ANDREA
Last Name:JACKSON
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1171 THOMASWOOD DR APT 101
Mailing Address - Street 2:
Mailing Address - City:WHITSETT
Mailing Address - State:NC
Mailing Address - Zip Code:27377-0017
Mailing Address - Country:US
Mailing Address - Phone:877-769-7411
Mailing Address - Fax:
Practice Address - Street 1:1171 THOMASWOOD DR APT 101
Practice Address - Street 2:
Practice Address - City:WHITSETT
Practice Address - State:NC
Practice Address - Zip Code:27377-0017
Practice Address - Country:US
Practice Address - Phone:877-769-7411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-08
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP012363104100000X
NCC0135571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker