Individual
CASIEL DOMINIQUE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LAC
Contact information
Practice address
1705 W MAIN ST, MESA, AZ 85201-6920
(877) 809-5092
Mailing address
45464 W LONG WAY, MARICOPA, AZ 85139-7074
(248) 934-9060
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LAC-7258T
AZ
Other
Enumeration date
08/25/2022
Last updated
08/25/2022
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