Individual
CONNIE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1410 RANCH ROAD 2900 STE 303, KINGSLAND, TX 78639-5853
(830) 499-3744
Mailing address
1203 FORD ST, LLANO, TX 78643-2611
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
13344
TX
101YP2500X
Professional Counselor
Primary
74377
TX
Other
Enumeration date
03/15/2017
Last updated
10/02/2019
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