Individual
SHAINA M JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
609 W JOHNSON AVE STE 400, CHESHIRE, CT 06410-4505
(855) 284-7483
(617) 807-0958
Mailing address
PO BOX 748465, ATLANTA, GA 30374-8465
(855) 284-7483
(617) 807-0958
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
5160
CT
Other
Enumeration date
01/05/2023
Last updated
01/05/2023
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