Individual
JACQUELINE MAYES JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
2904 HARVEST LN, ALBANY, GA 31721-4555
(229) 449-0805
(229) 449-0805
Mailing address
994 LAMAR RD, MACON, GA 31210-7109
(229) 449-0805
(229) 449-0805
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
CSW002881
GA
Other
Enumeration date
02/06/2007
Last updated
10/04/2013
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