Individual
MS. MARY THERESA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
345 OLD CUYLER RD, ELLABELL, GA 31308-5858
(912) 320-3205
Mailing address
345 OLD CUYLER RD, ELLABELL, GA 31308-5858
(912) 320-3205
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
Primary
LPC011711
GA
Other
Enumeration date
05/13/2016
Last updated
11/27/2023
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