Individual
NINA YVONNE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
34841 VETERANS PLZ, WAYNE, MI 48184-1733
(313) 292-7640
(313) 292-9270
Mailing address
34841 VETERANS PLZ, WAYNE, MI 48184-1733
(313) 292-7640
(313) 292-9270
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
6401007953
MI
Other
Enumeration date
06/11/2018
Last updated
06/11/2018
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