Individual
AQUANATTE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
5059 HAYES ST, GARY, IN 46408-4355
(256) 797-1363
Mailing address
5059 HAYES ST, GARY, IN 46408-4355
(256) 797-1363
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
08/11/2011
Last updated
03/28/2025
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