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Individual

MR. JACARRI DEANDRELL JACKSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
343 GASTON LN, BOSSIER CITY, LA 71112-4270
(318) 461-2256
Mailing address
238 WILDWOOD ST, MANSFIELD, LA 71052-6420
(318) 465-1790

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
101YM0800X
Mental Health Counselor
171M00000X
Case Manager/Care Coordinator
Primary

Other

Enumeration date
02/23/2016
Last updated
11/30/2020
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