Individual
MS. MYRIKLE ALESIA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BACHELOR OF SCIENCE
Contact information
Practice address
862 ONEAL LN, BATON ROUGE, LA 70816-1874
(225) 275-3039
Mailing address
862 ONEAL LN, BATON ROUGE, LA 70816-1874
(225) 275-3039
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101YM0800X
—
LA
Enumeration date
03/28/2018
Last updated
03/28/2018
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