Individual
MRS. CAROL DENISE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ACADC
Contact information
Practice address
1522 17TH STREET, DES MOINES, IA 50314-0000
(515) 279-0335
Mailing address
1522 17TH ST, DES MOINES, IA 50314-1418
(515) 279-0335
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
92151
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
X000202269
—
IA
Enumeration date
10/23/2009
Last updated
10/23/2009
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