Individual
LARA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1010 4TH AVE N, NASHVILLE, TN 37219-1110
(615) 417-3799
Mailing address
1010 4TH AVE N, NASHVILLE, TN 37219-1110
(615) 417-3799
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
3264
TN
Other
Enumeration date
07/24/2015
Last updated
07/24/2015
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