Individual
MR. CHRISTOPHER D. JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
9021 17TH AVE, KENOSHA, WI 53143-6806
(262) 220-8200
Mailing address
9021 17TH AVE, KENOSHA, WI 53143-6806
(262) 220-8200
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
008376
NY
101YM0800X
Mental Health Counselor
Primary
6786-125
WI
Other
Enumeration date
12/03/2017
Last updated
08/16/2022
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