Individual
JACOYIA MICHELLE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1115 BALL AVE NE, GRAND RAPIDS, MI 49505-5904
(616) 901-8289
Mailing address
1115 BALL AVE NE, GRAND RAPIDS, MI 49505-5904
(616) 648-7817
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
—
—
Other
Enumeration date
11/13/2019
Last updated
07/09/2020
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