Individual
JAQUAY JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CMHT
Contact information
Practice address
119 S 12TH AVE, LAUREL, MS 39440-4322
(601) 342-8215
Mailing address
860 E RIVER PL STE 100, JACKSON, MS 39202-3442
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
101YM0800X
Mental Health Counselor
—
MS
Other
Enumeration date
07/02/2019
Last updated
07/02/2019
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