Provider Demographics
NPI:1689402281
Name:JACKSON, CASSANDRA LOVETTE (COUNSELOR)
Entity type:Individual
Prefix:MS
First Name:CASSANDRA
Middle Name:LOVETTE
Last Name:JACKSON
Suffix:
Gender:F
Credentials:COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1042 WE ROSS PKWY W
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-8424
Mailing Address - Country:US
Mailing Address - Phone:901-846-7559
Mailing Address - Fax:
Practice Address - Street 1:1042 WE ROSS PKWY W
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-8424
Practice Address - Country:US
Practice Address - Phone:901-846-7559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-24
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional