Individual
CHELSA T JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2504 RIDGE LAKE DR, SHREVEPORT, LA 71109-3020
(318) 518-1174
Mailing address
2504 RIDGE LAKE DR, SHREVEPORT, LA 71109-3020
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
LA
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
11/08/2015
Last updated
09/04/2020
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