Individual
LARISSA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS
Contact information
Practice address
1720 LEXINGTON RD STE A, ATHENS, GA 30605-2330
(706) 543-3522
(706) 543-3523
Mailing address
1720 LEXINGTON RD STE A, ATHENS, GA 30605-2330
(706) 543-3522
(706) 543-3523
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LPC009037
GA
Other
Enumeration date
10/24/2022
Last updated
10/24/2022
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