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Individual

LESA DIANE JACKSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MSW

Contact information

Practice address
302 ROLLING KNOLL DR, COLUMBIA, SC 29229-9298
(254) 290-8980
Mailing address
302 ROLLING KNOLL DR, COLUMBIA, SC 29229-9298
(254) 290-8980

Taxonomy

Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary

Other

Enumeration date
07/29/2009
Last updated
07/29/2009
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