Individual
GAIL E JACKSON
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
LISW
Contact information
Practice address
625 TRUMAN ST NE, ALBUQUERQUE, NM 87110-6443
(505) 272-6916
Mailing address
1108 CALLE DEL RANCHERO NE, ALBUQUERQUE, NM 87106-1906
(505) 256-4742
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
I-0090
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
80529275
—
NM
Enumeration date
11/04/2005
Last updated
07/09/2007
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