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Individual
MRS. TIERRA JACKSON
Active
Individual
MRS. TIERRA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPCA, LMFTA, RMFTI
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
A10704
NC
106H00000X
Marriage & Family Therapist
9096A
NC
106H00000X
Marriage & Family Therapist
Primary
IMT2200
FL
Other
Enumeration date
05/21/2014
Last updated
12/17/2014
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