OrganizationActive
Janissa D Jackson PHD PLLC
NPI 1871762476 · Clinical Child & Adolescent Psychologist · Fayetteville, AR
Provider details
- NPI number
- 1871762476
- Entity type
- Organization
- Primary specialty
- Clinical Child & Adolescent PsychologistBehavioral Health & Social Service Providers
- Organization subpart
- No
- Authorized official
- Lavonna Latta, Business Manager(479) 443-5575
- License
- 07-01P (AR)
Specialties & taxonomies
Behavioral Health & Social Service Providers
Behavioral Health & Social Service Providers
Practice location
1 W Sunbridge Dr
Fayetteville, AR 72703-1825
Phone: (479) 443-5575
Fax: (479) 443-9554
Approximate (ZIP-level) locationGet directions
Mailing address
1 W Sunbridge Dr
Fayetteville, AR 72703-1825
Other names (DBA / former)
- Doing business as
- Janissa D Jackson PHD
Registry dates
- Enumerated
- 2008-02-27
- Last updated
- 2008-02-27
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.