Individual
DESTINY JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.A., PLPC, PLMFT
Contact information
Practice address
3341 YOUREE DR, 101, SHREVEPORT, LA 71105-2149
(318) 219-4171
Mailing address
6129 WINCANTON DR, SHREVEPORT, LA 71129-3908
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
LA
Other
Enumeration date
09/07/2016
Last updated
09/07/2016
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