Individual
ELIZABETH MARIE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, TLLP
Contact information
Practice address
43155 MAIN ST, ATRIUM 2300 SUITE I, NOVI, MI 48375-1777
(734) 656-8191
Mailing address
8566 CADILLAC CIR, GROSSE ILE, MI 48138-2216
(734) 770-9070
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6301016009
MI
Other
Enumeration date
01/04/2016
Last updated
05/17/2016
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