Individual
TECHINA CHANTA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CDCA 161767
Contact information
Practice address
515 MARTIN DR, XENIA, OH 45385-1615
(937) 562-2400
(937) 562-2450
Mailing address
515 MARTIN DR, XENIA, OH 45385-1615
(773) 815-4908
(937) 562-2450
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
161767
OH
Other
Enumeration date
12/29/2018
Last updated
12/29/2018
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