Individual
LATASHA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5135 DEVERON ST STE B, GREENVILLE, NC 27834-7530
(252) 406-0576
Mailing address
5135 DEVERON ST STE B, GREENVILLE, NC 27834-7530
(919) 740-8056
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
HC7950
NC
3747P1801X
Personal Care Attendant
—
—
Other
Enumeration date
01/25/2023
Last updated
06/01/2025
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