Individual
MISS PATRICIA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW
Contact information
Practice address
11457 SHOEMAKER ST, DETROIT, MI 48213-3418
(313) 331-3435
(313) 921-4125
Mailing address
11457 SHOEMAKER ST, DETROIT, MI 48213-3418
(313) 331-3435
(313) 921-4125
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
J250676067437
MSW
MI
Enumeration date
04/20/2007
Last updated
07/08/2007
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