Individual
SHIRLEY MCMILLAN JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2117 LUCKNER CT, MOBILE, AL 36618-2618
(251) 423-8197
(251) 452-4797
Mailing address
410 S WILSON AVE, PRICHARD, AL 36610-3910
(251) 423-1897
(251) 452-4797
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
03/17/2014
Last updated
03/17/2014
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