Individual
EVELYN JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
209 MILLER LOOP, FORT BENNING, COLUMBUS, GA 31905-6560
(706) 545-1661
Mailing address
209 MILLER LOOP, FORT BENNING, COLUMBUS, GA 31905-6560
(706) 545-1661
Taxonomy
Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
Primary
LCSW
LA
Other
Enumeration date
09/28/2006
Last updated
07/08/2007
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