Individual
LISA KATHRYN JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPCC
Contact information
Practice address
3025 FLORIDA ST NE, ALBUQUERQUE, NM 87110-2614
(505) 417-6744
Mailing address
4312 CARLISLE BLVD NE, ALBUQUERQUE, NM 87107-4811
(505) 323-3785
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
0124141
NM
Other
Enumeration date
02/26/2007
Last updated
01/21/2021
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