| Joseph Granville Jackson, CCS, RAC | |
|
411 Sparrow St, Lake Providence, LA 71254-3035 | |
| (318) 559-3356 | |
| (318) 559-2044 |
| Full Name | Joseph Granville Jackson |
|---|---|
| Gender | Male |
| Speciality | Counselor - Addiction (substance Use Disorder) |
| Location | 411 Sparrow St, Lake Providence, Louisiana |
| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891152773 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | 186 (Louisiana) | Primary |
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | 1300 (Louisiana) | Secondary |
| Mailing Address | Practice Location Address |
|---|---|
| Joseph Granville Jackson, CCS, RAC 706 Sparrow St, Lake Providence, LA 71254-3520 Ph: (318) 559-3356 | Joseph Granville Jackson, CCS, RAC 411 Sparrow St, Lake Providence, LA 71254-3035 Ph: (318) 559-3356 |
Wanda Shoemaker, Counselor Medicare: Not Enrolled in Medicare Practice Location: 306 Star Arlington St, Lake Providence, LA 71254 Phone: 318-372-0016 | |
Larrimi Shae Williams, Counselor Medicare: Not Enrolled in Medicare Practice Location: 1700 Lake St, Lake Providence, LA 71254 Phone: 318-559-0551 Fax: 318-559-0538 | |
Terry Glen Jordan, MS, LPC Counselor Medicare: Not Enrolled in Medicare Practice Location: 500 Lake St Ste B, Lake Providence, LA 71254 Phone: 318-552-5016 | |
Laketha Lyons, Counselor Medicare: Not Enrolled in Medicare Practice Location: 331 Keene St, Lake Providence, LA 71254 Phone: 318-282-0614 | |
Edna King, Counselor Medicare: Not Enrolled in Medicare Practice Location: 1024 3rd St, Lake Providence, LA 71254 Phone: 318-282-1649 | |
Shirley Anne Lyons, Counselor Medicare: Not Enrolled in Medicare Practice Location: 1700 Lake St, Lake Providence, LA 71254 Phone: 318-559-0551 | |
Ashley Johnson, 101YM0800X Counselor Medicare: Not Enrolled in Medicare Practice Location: 1700 Lake St, Lake Providence, LA 71254 Phone: 318-559-0414 |