Individual
EVELENA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LBSW
Contact information
Practice address
1135 GREGG HWY, AIKEN, SC 29801-6341
(803) 641-7700
(803) 641-7709
Mailing address
1135 GREGG HWY, AIKEN, SC 29801-6341
(803) 641-7700
(803) 641-7709
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
004393
SC
Other
Enumeration date
11/30/2006
Last updated
07/08/2007
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