Provider Demographics
NPI:1174302491
Name:LESTER-JACKSON, K'NEADEE (MSW, LCSWA)
Entity type:Individual
Prefix:
First Name:K'NEADEE
Middle Name:
Last Name:LESTER-JACKSON
Suffix:
Gender:F
Credentials:MSW, LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7516 HUBBARD WOODS RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-0138
Mailing Address - Country:US
Mailing Address - Phone:585-414-3479
Mailing Address - Fax:
Practice Address - Street 1:7516 HUBBARD WOODS RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-0138
Practice Address - Country:US
Practice Address - Phone:585-414-3479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0187521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical