Individual
EBONY JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1655 BURLINGTON PIKE STE 101, FLORENCE, KY 41042-4909
(859) 992-2692
Mailing address
6060 CELTIC ASH AVE, FLORENCE, KY 41042-1795
(859) 209-6823
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
253805
KY
Other
Enumeration date
04/22/2019
Last updated
01/14/2021
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