Individual
MRS. CHARLOTTE CONSUELO JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2701 17TH ST, ROCK ISLAND, IL 61201-5351
(309) 779-2031
Mailing address
2701 17TH ST, ROCK ISLAND, IL 61201-5351
(309) 779-2031
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
Primary
—
—
Other
Enumeration date
09/06/2022
Last updated
05/14/2025
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