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Organization
SUPPORTIVE CHANGE COUNSELING & CONSULTING
Active
Organization
SUPPORTIVE CHANGE COUNSELING & CONSULTING
Active
Other names
Supportive Change Counseling
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ANTOINE JACKSON LPCC (OWNER / CLINICAL DIRECTOR)
(612) 367-7287
Entity
Organization
Contact information
Practice address
2335 WOODBRIDGE ST APT 338, ROSEVILLE, MN 55113-4763
(612) 367-7287
Mailing address
202 N CEDAR AVE STE 1, OWATONNA, MN 55060-2306
(612) 367-7287
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
NULL
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
08/20/2025
Last updated
08/20/2025
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