Individual
KIESHA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
30000 HIVELEY ST, INKSTER, MI 48141-1089
(313) 218-6832
Mailing address
22200 W 11 MILE RD UNIT 3663, SOUTHFIELD, MI 48037-7107
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
05/13/2021
Last updated
06/16/2021
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