Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Jalisa Jackson

Individual provider Mental Illness Community Based Residential Treatment Facility · NPI 1366041667

Jalisa Jackson is a Mental Illness Community Based Residential Treatment Facility in Charlotte, North Carolina. Practices as a sole proprietor. Licensed in North Carolina.

Licensed in
NC
In the registry since
2020
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Practice location Address checks out

11413 Mangla Dr
Charlotte, NC 28214-8885
Phone: (704) 819-4909
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Mental Illness Community Based Residential Treatment Facility (primary) Taxonomy 320800000X · Licence MHL-036-348 (NC)

Record details

NPI number1366041667
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedOctober 19, 2020
Last updated in NPPESOctober 19, 2020
Certification dateOctober 19, 2020

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