Individual
MS. TRACIE DENEICE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, PC2
Contact information
Practice address
6005 FINANCIAL PLZ, SHREVEPORT, LA 71129-2615
(318) 632-2040
(318) 632-2073
Mailing address
6005 FINANCIAL PLZ, SHREVEPORT, LA 71129-2615
(318) 632-2040
(318) 632-2073
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
3384
LA
Other
Enumeration date
07/03/2006
Last updated
07/08/2007
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