Provider Demographics
NPI:1649169541
Name:JACKSON EVOLUTIONARY THERAPEUTIC SOLUTIONS PLLC
Entity type:Organization
Organization Name:JACKSON EVOLUTIONARY THERAPEUTIC SOLUTIONS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CLAUDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:984-212-3076
Mailing Address - Street 1:48 GLADWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-6588
Mailing Address - Country:US
Mailing Address - Phone:984-212-3076
Mailing Address - Fax:
Practice Address - Street 1:48 GLADWOOD WAY
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-6588
Practice Address - Country:US
Practice Address - Phone:984-212-3076
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-02
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty