Individual
MONIQUE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LLPC
Contact information
Practice address
4410 W 13 MILE RD, ROYAL OAK, MI 48073-6515
(248) 554-6414
Mailing address
31600 SCHOENHERR RD APT 12, WARREN, MI 48088-1919
(313) 721-7474
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
6401017459
MI
Other
Enumeration date
07/10/2019
Last updated
07/10/2019
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