Individual ProviderKristie JacksonCounselorBehavioral Health & Social Service ProvidersPractice Address1644 Carter St, Suite 2, Vidalia, LA 71373-3143(318) 414-3065PECOS EnrollmentBased on the most recent information from CMS, provider Kristie Jackson does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 9:54 AM.Profile DetailsProvider ID1639629454Provider TypeIndividualFull NameJackson, KristieGenderFemaleSole ProprietorNoEnumeration Date10/4/2016Last Updated10/4/2016Contact InformationPractice LocationPractice Address1644 Carter St, Suite 2, Vidalia, LA 71373-3143Phone(318) 414-3065Fax(318) 414-3067Mailing LocationMailing Address1644 Carter St, Suite 2, Vidalia, LA 71373-3143Phone(318) 414-3065Fax(318) 414-3067Provider TaxonomiesCodeDescriptionLicenseCode101YM0800XPrimaryDescriptionCounselorBehavioral Health & Social Service ProvidersLicenseUnlisted Issuer