Individual
MALEA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
11861 COURSEY BLVD, BATON ROUGE, LA 70816-4404
(225) 612-8656
Mailing address
11861 COURSEY BLVD, BATON ROUGE, LA 70816-4404
(225) 612-8656
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
08/29/2024
Last updated
08/29/2024
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