Individual
MARILYN SLEDGE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
2325 BRIAR GATE DR, MONTGOMERY, AL 36116-2154
(334) 215-1048
Mailing address
2325 BRIAR GATE DR, MONTGOMERY, AL 36116-2154
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2160C
AL
1041C0700X
Clinical Social Worker
5411455-3501
UT
1041C0700X
Clinical Social Worker
CSW003706
GA
Other
Enumeration date
11/06/2010
Last updated
11/06/2010
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