Individual
LAVESHA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
341 TENNESSEE RD, GAINESTOWN, AL 36540
(251) 387-9551
Mailing address
341 TENNESSEE RD, GAINESTOWN, AL 36540-3836
(251) 387-9551
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
AL
Other
Enumeration date
02/23/2026
Last updated
02/23/2026
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