Individual
ANGELA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1607 BRADMERE LN, LITHIA SPRINGS, GA 30122-3253
(678) 761-2770
Mailing address
1607 BRADMERE LN, LITHIA SPRINGS, GA 30122-3253
(678) 761-2770
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
2020-12959
GA
Other
Enumeration date
01/17/2021
Last updated
01/17/2021
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