Individual
TAMICKCO MARIA DEEN JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MENTAL HEALTH COUNSE
Contact information
Practice address
941 KAMEHAMEHA HWY STE 204, PEARL CITY, HI 96782-2516
(808) 633-0405
Mailing address
PO BOX 3171, MILILANI, HI 96789
(808) 633-0405
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
MHC-418
HI
Other
Enumeration date
04/06/2018
Last updated
04/06/2018
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