Individual
LATOSHA M JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
6 CHENELL DR STE 100, CONCORD, NH 03301-8514
(402) 469-6899
Mailing address
1 HARDY RD # 128, BEDFORD, NH 03110-4915
(402) 469-6899
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
2108
NE
1041C0700X
Clinical Social Worker
1822
NE
1041C0700X
Clinical Social Worker
Primary
2138
NH
Other
Enumeration date
06/17/2013
Last updated
12/23/2021
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