Provider Demographics
NPI:1447702063
Name:JACKSON, REBECCA KAYE (MSW, LCSW)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:KAYE
Last Name:JACKSON
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:MISS
Other - First Name:REBECCA
Other - Middle Name:KAYE
Other - Last Name:PFAFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:284 EXECUTIVE PARK DR STE 100
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-1833
Mailing Address - Country:US
Mailing Address - Phone:704-939-1100
Mailing Address - Fax:704-939-1173
Practice Address - Street 1:232 NEWSOME RD
Practice Address - Street 2:
Practice Address - City:KING
Practice Address - State:NC
Practice Address - Zip Code:27021-8507
Practice Address - Country:US
Practice Address - Phone:336-983-0941
Practice Address - Fax:336-983-0958
Is Sole Proprietor?:No
Enumeration Date:2016-10-31
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0100341041C0700X
VA09040120101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical