Organization
PASSION 4 KIDS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CASSONDRA JACKSON LAPC (MENTAL HEALTH CLINICIAN)
(678) 492-9332
Entity
Organization
Contact information
Practice address
1076 HAWTHORN LN, GRAYSON, GA 30017-4208
(678) 492-9332
Mailing address
1076 HAWTHORN LN, GRAYSON, GA 30017-4208
(678) 492-9332
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
APC004749
GA
Other
Enumeration date
03/11/2015
Last updated
03/11/2015
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