Individual
MRS. EBONY CHANTRICE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CHW INSTRUCTOR
Contact information
Practice address
11510 HOMESTEAD RD STE 295, HOUSTON, TX 77016-1237
(713) 816-1629
Mailing address
15267 MORNING DOVE DR, HUMBLE, TX 77396-2294
(281) 736-0806
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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