Individual
DR. ALYCE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
1616 WALNUT ST, SUITE 910, PHILADELPHIA, PA 19103-5313
(215) 922-2826
Mailing address
922 PINE ST, 2-R, PHILADELPHIA, PA 19107-6100
(215) 922-2826
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PS-006130-L
PA
Other
Enumeration date
06/05/2007
Last updated
07/08/2007
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