Individual
JAQUINDA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
638 TIMBER WALK DR, SIMPSONVILLE, SC 29681-4554
(864) 451-9443
Mailing address
309 SE MAIN ST, SUITE 207, SIMPSONVILLE, SC 29681-2653
(864) 451-9443
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
6505
SC
Other
Enumeration date
03/22/2017
Last updated
05/01/2017
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