Individual
STACEY N JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
L.C.S.W. P.I.P
Contact information
Practice address
1615 KATHY LN SW, PO BX 2240, DECATUR, AL 35603-1026
(256) 306-4128
(256) 432-2015
Mailing address
1615 KATHY LN SW, PO BX 2240, DECATUR, AL 35603-1026
(256) 306-4128
(256) 432-2015
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
1798-C
AL
Other
Enumeration date
10/06/2006
Last updated
08/05/2011
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