Individual
LATOYA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4108 HARVEY ST, MONROE, LA 71203-5746
(318) 473-5373
Mailing address
4108 HARVEY ST, MONROE, LA 71203-5746
(318) 473-5373
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CIT-5095
LA
Other
Enumeration date
09/07/2021
Last updated
09/07/2021
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