Individual
TOMMY JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LAC
Contact information
Practice address
6601 W 12TH ST, LITTLE ROCK, AR 72204-1513
(501) 666-8686
(501) 660-6829
Mailing address
PO BOX 251970, LITTLE ROCK, AR 72225-1970
(501) 666-8686
(501) 660-6830
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
A2303008
AR
Other
Enumeration date
07/25/2023
Last updated
07/25/2023
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