Provider Demographics
NPI:1184413288
Name:JACKSON, MIRACLE (LMSW)
Entity type:Individual
Prefix:
First Name:MIRACLE
Middle Name:
Last Name:JACKSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:378 W CHESTNUT ST STE 205
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-4661
Mailing Address - Country:US
Mailing Address - Phone:724-225-6940
Mailing Address - Fax:724-225-6811
Practice Address - Street 1:378 W CHESTNUT ST STE 205
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-4661
Practice Address - Country:US
Practice Address - Phone:724-225-6940
Practice Address - Fax:724-225-6811
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health