Individual
AMANI AYISHA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1825 MARIKA RD, FAIRBANKS, AK 99709-5521
(907) 474-0890
Mailing address
6631 E 9TH AVE, ANCHORAGE, AK 99504-1725
(305) 994-4251
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
222527
AK
172V00000X
Community Health Worker
—
—
Other
Enumeration date
07/22/2021
Last updated
05/09/2024
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