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

Individual provider Clinical Social Worker · NPI 1407743164

Johnathon Dean Jackson, LCSWA is a Clinical Social Worker in Fayetteville, North Carolina. Practices as a sole proprietor. Licensed in North Carolina.

Licensed in
NC
In the registry since
2025
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Practice location Address checks out

351 Wagoner Dr Ste 411
Fayetteville, NC 28303-4608
Phone: (910) 994-2818
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X · Licence P022036 (NC)

Record details

NPI number1407743164
Entity typeIndividual (Type 1)
GenderMale
Credentials LCSWA
Sole proprietorYes
NPI enumeratedJune 23, 2025
Last updated in NPPESJune 23, 2025
Certification dateJune 23, 2025

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