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Organization
JACKSON INNOVATIONS PLLC
Active
Organization
JACKSON INNOVATIONS PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. GAYNELLA JACKSON LMSW (CLINICAL DIRECTOR)
(248) 569-9846
Entity
Organization
Contact information
Practice address
20700 CIVIC CENTER DR, SUITE 170, SOUTHFIELD, MI 48076-4140
(248) 569-9846
(248) 569-1919
Mailing address
20700 CIVIC CENTER DR, SUITE 170, SOUTHFIELD, MI 48076-4140
(248) 569-9846
(248) 569-1919
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
6801059515
MI
Other
Enumeration date
03/16/2007
Last updated
08/22/2020
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