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Individual
MARTINA SHAUNTAE JACKSON
Active
Individual
MARTINA SHAUNTAE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
178.014194
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
178.014194
LICENSED PROFESSIONAL COUNSELOR
IL
Enumeration date
04/27/2020
Last updated
04/27/2020
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