Individual
MICHELE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
2306 VERONA CT, HARKER HEIGHTS, TX 76548-8855
(912) 572-7273
Mailing address
2306 VERONA CT, HARKER HEIGHTS, TX 76548-8855
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
64908
TX
1041C0700X
Clinical Social Worker
P013052
NC
Other
Enumeration date
06/11/2019
Last updated
06/11/2019
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