Individual
KRISTIE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1644 CARTER ST, SUITE 2, VIDALIA, LA 71373-3143
(318) 414-3065
(318) 414-3067
Mailing address
1644 CARTER ST, SUITE 2, VIDALIA, LA 71373-3143
(318) 414-3065
(318) 414-3067
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
10/04/2016
Last updated
10/04/2016
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