Joseph Granville Jackson, CCS, RAC
Individual provider Active NPI Addiction (Substance Use Disorder) Counselor · Lake Providence, LA
NPI 1891152773 · NPPES record last updated Jan 22, 2016
Key facts
- NPI
- 1891152773
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Addiction (Substance Use Disorder) Counselor 101YA0400X
- License
- 186 (LA)
- Practice address
- 411 Sparrow St
Lake Providence, LA 71254-3035 - Phone
- (318) 559-3356
- Fax
- (318) 559-2044
- NPI assigned
- Jan 22, 2016
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Delta Community Action Association, Inc. | Past | Accepting new patients | |
| Delta Community Enhancement Program | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 186 | LA | Yes |
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 1300 | LA |
Addresses
Primary practice location
411 Sparrow St
Lake Providence, LA 71254-3035
Mailing address
706 Sparrow St
Lake Providence, LA 71254-3520
Phone (318) 559-3356
Other providers in Lake Providence, LA
- Sarah Holt
- Jensen Taylor Howard
- Integrity Transportation, LLC
- Helen Jackson
- James Jackson
- Lazorria Nicole Jackson
- Mishelai Ariyan James
- Harriet Hope Johnson
- Clifton Jones Jr.
- Terry Glen Jordan
All providers in Lake Providence, LA · Addiction (Substance Use Disorder) Counselor in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 22, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.