Individual
MS. ANTOINETTE RACHEL JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
13101 ALLEN RD, SOUTHGATE, MI 48195-2216
(734) 785-7700
Mailing address
12433 BIRWOOD ST, DETROIT, MI 48204-1022
(248) 372-1850
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
01/17/2022
Last updated
11/06/2024
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