Individual
ANTHONY DELJUAN JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
175 GWINNETT DR, LAWRENCEVILLE, GA 30046-8444
(678) 209-2394
Mailing address
1200 BROOKSTONE CIR, CONYERS, GA 30012-0327
(470) 564-9487
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
01/31/2025
Last updated
07/11/2025
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