Individual
MR. LEON TREMAIN JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
EDS, MS, NCC, LPC
Contact information
Practice address
1115B OPENWOOD ST, VICKSBURG, MS 39183-2533
(318) 341-2202
(601) 501-1030
Mailing address
1115B OPENWOOD ST, VICKSBURG, MS 39183-2533
(318) 341-2202
(601) 501-1030
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
2016
MS
101YA0400X
Addiction (Substance Use Disorder) Counselor
2016
MS
101YM0800X
Mental Health Counselor
2016
MS
101YP2500X
Professional Counselor
2016
MS
106H00000X
Marriage & Family Therapist
2016
MS
Other
Enumeration date
08/14/2015
Last updated
08/14/2015
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