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Individual

LORA J JACKSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MS, LPC, NCC

Contact information

Practice address
110 W MAIN ST, EVERETT, PA 15537-1131
(814) 652-2650
Mailing address
PO BOX 398, 10309 GREENWOOD STREET, ELLERSLIE, MD 21529-0398
(301) 697-6199

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
LC2939
MD
101Y00000X
Counselor
Primary
PC005514
PA

Other

Enumeration date
06/29/2010
Last updated
06/29/2010
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