Individual
TRACEE LOUISE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
22901 W INDUSTRIAL DR STE 105, SAINT CLAIR SHORES, MI 48080-1130
(313) 980-1254
Mailing address
482 ALLARD AVE, GROSSE POINTE FARMS, MI 48236-2812
(313) 980-1254
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
6401011830
MI
Other
Enumeration date
10/25/2012
Last updated
06/25/2025
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