Individual
CHANTILLE UNIQUE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW, LSW
Contact information
Practice address
202 E BAGLEY RD, BEREA, OH 44017-2058
(440) 260-8300
Mailing address
202 E BAGLEY RD, BEREA, OH 44017-2058
(440) 260-8300
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
S.1101606
OH
Other
Enumeration date
06/06/2012
Last updated
06/06/2012
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