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Individual

CARROLL S JACKSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
L.I.S.W.

Contact information

Practice address
4130 LINDEN AVE, SUITE 250, DAYTON, OH 45432-3015
(937) 681-9644
Mailing address
6504 SEMMES LN, DAYTON, OH 45424-7117
(937) 681-9644

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
I.0009433
OH

Other

Enumeration date
11/03/2015
Last updated
12/11/2015
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