Individual
MRS. TAKIYAH JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA TLLP
Contact information
Practice address
420 W 5TH AVE, FLINT, MI 48503-2445
(810) 257-3714
(810) 762-5234
Mailing address
420 W 5TH AVE, FLINT, MI 48503-2445
(810) 257-3714
(810) 762-5234
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6301014667
MI
Other
Enumeration date
02/03/2012
Last updated
02/03/2012
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