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JALISA JACKSON
NPI 1366041667
Community Based Residential Treatment Facility, Mental Illness in Charlotte, NC

Active since October 19, 2020
11413 MANGLA DR, CHARLOTTE, NC 28214(704) 819-4909 Get Directions Write a Review

NPPES record last updated: October 19, 2020. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Jalisa Jackson NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JALISA JACKSON (NPI 1366041667) is an individual community based residential treatment facility, mental illness provider in Charlotte, North Carolina, licensed in North Carolina (MHL-036-348) and active in the NPI registry since October 2020.

NPPES Registry Identity

NPI1366041667
Entity TypeIndividualFemale
Primary Taxonomy320800000X
Provider Legal NameJALISA JACKSON
Location Address11413 MANGLA DRCharlotte, NC 28214-8885
Mailing Address11413 Mangla DrCharlotte, NC 28214-8885 · (704) 819-4909
Phone(704) 819-4909
Sole ProprietorYes
Enumeration DateOctober 19, 2020
NPPES CertifiedOctober 19, 2020
✔ NPI 1366041667 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCommunity Based Residential Treatment Facility, Mental IllnessResidential Treatment Facilities
Taxonomy Code320800000X
License✔ Licensed in NC · MHL-036-348
Definition
A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness.
11413 MANGLA DR, Charlotte, NC 28214
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Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

URBANIZED LLC
Community Based Residential Treatment Facility, Mental Illness
11413 MANGLA DR
CHARLOTTE, NC 28214
Mecklenburg County (980) 258-2704

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jalisa Jackson's NPI number?

The NPI number for Jalisa Jackson is 1366041667. It was assigned to this individual provider in the NPPES registry on October 19, 2020.

Where is Jalisa Jackson located?

Jalisa Jackson practices at 11413 Mangla Dr, Charlotte, NC 28214. The listed phone number is (704) 819-4909.

What is Jalisa Jackson's specialty?

The primary specialty registered for this NPI is Community Based Residential Treatment Facility, Mental Illness with taxonomy code 320800000X.

When was this NPI record last updated?

The NPPES record for Jalisa Jackson was last updated on October 19, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.