Individual
ANTOINE DESHAWN JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA, LPCC
Contact information
Practice address
2335 WOODBRIDGE ST APT 338, ROSEVILLE, MN 55113-4763
(612) 715-4071
Mailing address
2335 WOODBRIDGE ST APT 338, ROSEVILLE, MN 55113-4763
(612) 715-4071
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
3145
MN
Other
Enumeration date
02/18/2022
Last updated
11/14/2024
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