Individual
GLORIA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
800 N. RAINBOW BLVD SUITE 215, LAS VEGAS, NV 89107
(702) 968-0231
Mailing address
800.N.RAIBOW BLVD SUITE 215, LAS VEGAS, NV 89107-1103
(702) 968-0231
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
101YA0400X
NV
103K00000X
Behavior Analyst
103K000000X
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
22540000X
—
NV
Enumeration date
10/21/2014
Last updated
10/21/2014
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