Individual
MRS. SANDRA G. JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPCC
Contact information
Practice address
1900 E. TENTH STREET, ALAMOGORDO, NM 88310
(575) 437-7404
(575) 439-2860
Mailing address
1320 S. SOLANO, LAS CRUCES, NM 88001
(575) 527-7900
(575) 571-4872
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
0112141
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
18677037
—
NM
05
—
94206708
—
NM
Enumeration date
08/01/2006
Last updated
03/29/2014
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