Individual
MR. ANTIMOORE H. JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
14617 SARA DR, LITTLE ROCK, AR 72206-5410
(501) 952-5275
(501) 888-3576
Mailing address
14617 SARA DR, LITTLE ROCK, AR 72206-5410
(501) 952-5275
(501) 888-3576
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
1568-C
AR
Other
Enumeration date
05/08/2007
Last updated
07/09/2007
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