JANISSA D JACKSON PHD - NPI 1871762476 - Psychologist in Fayetteville, AR

Q: What is Janissa D Jackson Phd PLLC's NPI number?

The NPI number for Janissa D Jackson Phd PLLC is 1871762476. It was assigned to this organization in the NPPES registry on February 27, 2008. The provider is doing business as Janissa D Jackson Phd.

Q: What is Janissa D Jackson Phd PLLC's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical Child & Adolescent, with taxonomy code 103TC2200X.

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About Janissa D Jackson Phd NPPES

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

JANISSA D JACKSON PHD (NPI 1871762476) is a healthcare organization registered as a clinical child & adolescent in Fayetteville, Arkansas and active in the NPI registry since February 2008. The organization lists Lavonna Latta, Business Manager, as its authorized official.

NPPES Registry Identity

NPI1871762476

Entity TypeOrganization

Primary Taxonomy103TC2200X

Legal Business NameJANISSA D JACKSON PHD PLLC

Location Address1 W SUNBRIDGE DRFayetteville, AR 72703-1825

Mailing Address1 W Sunbridge DrFayetteville, AR 72703-1825 · (479) 443-5575 · Fax (479) 443-9554

Phone(479) 443-5575

Fax(479) 443-9554

Organization SubpartNo

Authorized OfficialLavonna LattaBusiness Manager · (479) 443-5575

Enumeration DateFebruary 27, 2008

✔ NPI 1871762476 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPsychologist · Clinical Child & AdolescentBehavioral Health & Social Service Providers

Taxonomy Code103TC2200X

License✔ Licensed in AR · 07-01P

Definition

A psychologist who develops and applies scientific knowledge to the delivery of psychological services to infants, toddlers, children and adolescents within their social context. Of particular importance to the specialty of clinical child psychology is an understanding of the basic psychological needs of children and adolescents, and how the family and other social contexts influence the socio-emotional adjustment, cognitive development, behavioral adaptation and health status of children and adolescents.

Also ListedPsychologist · ClinicalTaxonomy 103TC0700X · License 07-01P (AR)

1 W SUNBRIDGE DR, Fayetteville, AR 72703

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Other Names 1

Doing Business AsJanissa D Jackson Phd

Other Identifiers 1

Other5A252AR · Bluecross Blueshield

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Other Providers at the Same Location NPPES 20

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

LAURA K CAMARGO LCSW

Social Worker