Individual
MS. MARY ELISABETH JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCPC
Contact information
Practice address
804 SOUTH OAKLAND AVE, CARBONDALE, IN 62901
(618) 203-3975
(618) 529-2182
Mailing address
804 S OAKLAND AVE, CARBONDALE, IL 62901-2555
(618) 203-3975
(618) 529-2182
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
180.007729
IL
Other
Enumeration date
02/25/2011
Last updated
02/25/2011
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