Provider Demographics
NPI:1366143505
Name:JACKSON, NADIRA KAI (MA, MHC-LP)
Entity type:Individual
Prefix:
First Name:NADIRA
Middle Name:KAI
Last Name:JACKSON
Suffix:
Gender:F
Credentials:MA, MHC-LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:918 E NEW YORK AVE APT 3B
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-1546
Mailing Address - Country:US
Mailing Address - Phone:646-963-1004
Mailing Address - Fax:
Practice Address - Street 1:29 W 36TH ST STE 502
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-7907
Practice Address - Country:US
Practice Address - Phone:516-714-5871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-14
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health