Individual
TONYA R JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, LPC-A
Contact information
Practice address
120 MONTAUK AVE, NEW LONDON, CT 06320-4828
(203) 435-5444
Mailing address
120 MONTAUK AVE, NEW LONDON, CT 06320-4828
(203) 435-5444
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
Primary
7228
CT
Other
Enumeration date
02/07/2023
Last updated
10/01/2024
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