Jackson, Diane R

Jackson, Diane R is an individual health care provider with primary practice located at 87 W 4Th St , Mansfield OH 44903-1672. She recently has 3 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Counselor, Behavioral Health & Social Service Providers / Mental Health, Behavioral Health & Social Service Providers / Pastoral. Behavioral Health & Social Service Providers / Counselor is her primary health care specialty. Jackson, Diane R can be contacted via phone (419) 526-4603.

Contact Information

Primary practice address
87 W 4Th St Mansfield OH 44903-1672
Phone: (419) 526-4603
Fax: (419) 526-4603
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Counselor 101Y00000X E.0003808-SUPV Ohio
Behavioral Health & Social Service Providers / Mental Health 101YM0800X E.0003808-SUPV Ohio
Behavioral Health & Social Service Providers / Pastoral 101YP1600X E.0003808-SUPV Ohio

Profile Details

NPI number 1811056658
LBN Legal business name Jackson, Diane R
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 7th, 2006
Last updated Jul 8th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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