Individual provider · Type 1 NPI

Jalisa Jackson

Mental Illness Community Based Residential Treatment Facility · Charlotte, NC

NPI number 1366041667 Active

Practice location

11413 Mangla Dr
Charlotte, NC 28214-8885

Call (704) 819-4909 Map

Specialties and licenses

TaxonomyCodeLicense
Mental Illness Community Based Residential Treatment Facility Primary 320800000XMHL-036-348 (NC)

Mental Illness Community Based Residential Treatment Facility: A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness.

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About NPI 1366041667

Jalisa Jackson's National Provider Identifier is 1366041667, issued on Oct 19, 2020. The primary taxonomy on file is Mental Illness Community Based Residential Treatment Facility (320800000X), and the practice location is in Charlotte, NC. The record was last updated on Oct 19, 2020.