Individual
WHITLEY V JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMFT
Contact information
Practice address
547 NORTH AVE STE 152, NEW ROCHELLE, NY 10801-2601
(646) 543-9735
Mailing address
547 NORTH AVE STE 152, NEW ROCHELLE, NY 10801-2601
(646) 543-9735
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
001764
NY
Other
Enumeration date
11/12/2021
Last updated
11/12/2021
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