Individual
JAMES JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1700 LAKE ST, LAKE PROVIDENCE, LA 71254-5208
(318) 559-0551
Mailing address
1700 LAKE ST, LAKE PROVIDENCE, LA 71254-5208
(318) 559-0551
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
LA
Other
Enumeration date
10/03/2016
Last updated
10/03/2016
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