Individual
SHANTELL M M JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
18256 ASHTON AVE, DETROIT, MI 48219-2957
(313) 475-6685
Mailing address
18256 ASHTON AVE, DETROIT, MI 48219-2957
(313) 475-6685
Taxonomy
Speciality
Code
Description
License number
State
101YP1600X
Pastoral Counselor
Primary
J250765585757
MI
Other
Enumeration date
02/24/2026
Last updated
02/24/2026
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