Individual
TINA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
280 1ST ST BLDG 23, HOLLOMAN AFB, NM 88330-8273
(575) 572-5676
(575) 572-1523
Mailing address
16351 I94, HOME ON THE RANGE, SENTINEL BUTTE, ND 58654-9500
(701) 872-3745
(701) 872-3748
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
4950
ND
Other
Enumeration date
03/03/2014
Last updated
07/26/2022
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