Individual
CLARISSA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCDC
Contact information
Practice address
3080 W WASHINGTON ST STE B, STEPHENVILLE, TX 76401-3756
(254) 965-5515
Mailing address
3080 W WASHINGTON ST STE B, STEPHENVILLE, TX 76401-3756
(254) 965-5515
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
12992
TX
Other
Enumeration date
04/09/2018
Last updated
04/09/2018
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