Individual
MRS. EBONY CHANTRICE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CHW INSTRUCTOR
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
—
—
171M00000X
Case Manager/Care Coordinator
—
—
172V00000X
Community Health Worker
Primary
794
TX
174H00000X
Health Educator
794
TX
Other
Enumeration date
10/27/2020
Last updated
04/09/2025
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