Organization
GENESEE COUNTY COMMUNITY MENTAL HEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TAKIYAH SHANI' JACKSON MA TLLP (CONSULTATIVE SERVICES)
(810) 257-3714
Entity
Organization
Contact information
Practice address
420 W 5TH AVE, FLINT, MI 48503-2445
(810) 257-3714
Mailing address
420 W 5TH AVE, FLINT, MI 48503-2445
(810) 257-3714
Taxonomy
Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
Primary
6301014667
MI
Other
Enumeration date
12/08/2010
Last updated
12/08/2010
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