Organization
DC JACKSON LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARITY JACKSON MS, LPC-S, LPCC (OWNER)
(940) 220-1684
Entity
Organization
Contact information
Practice address
25 GRIZZLY BEAR RUN RD, TAOS, NM 87571
(505) 523-0066
Mailing address
1335 PASEO DEL PUEBLO SUR # 249, TAOS, NM 87571-5972
(505) 523-0066
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
Other
Enumeration date
08/14/2024
Last updated
08/14/2024
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