Individual
TISSAN TILDEN JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
3450 HIGHWAY 80 W, JACKSON, MS 39209-7201
(601) 321-2400
(601) 985-5174
Mailing address
3450 HIGHWAY 80 W, JACKSON, MS 39209-7201
(601) 316-0951
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
C10433
MS
Other
Enumeration date
06/01/2009
Last updated
09/04/2024
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