Individual
MS. JOHANNA B. JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
S.S.P.
Contact information
Practice address
18 SPRUCE STREET, YORK, SC 29745-0770
(803) 684-1905
(803) 684-1907
Mailing address
PO BOX 770, 1475 EAST LIBERTY STREET, YORK, SC 29745-0770
(803) 684-9916
(803) 684-1903
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
207262
SC
Other
Enumeration date
08/23/2013
Last updated
08/23/2013
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