Individual
MS. LARITA JACKSON LEE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW, LSW, ACSW, DCSW
Contact information
Practice address
3623 WALLACE ST, PHILA, PA 19104-1932
(215) 301-1384
Mailing address
3623 WALLACE ST, PHILA, PA 19104-1932
(215) 301-1384
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
SW000401E
PA
Other
Enumeration date
03/21/2012
Last updated
03/21/2012
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