Individual
KEATHA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
11990 JACKSON ST, CLINTON, LA 70722-3210
(225) 683-5292
(225) 683-3411
Mailing address
25733 BLACKWELL RD, ANGIE, LA 70426-4017
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
9337
LA
1041C0700X
Clinical Social Worker
Primary
9337
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2449915
—
LA
Enumeration date
05/13/2015
Last updated
09/18/2018
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