Individual
GABRIELLE S JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
26300 OUTER DR, LINCOLN PARK, MI 48146-2019
(734) 643-0071
Mailing address
3876 HARVARD RD, DETROIT, MI 48224-2342
(313) 515-1964
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
6451023465
MI
Other
Enumeration date
03/08/2022
Last updated
02/05/2024
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