Individual
DR. MARY SEBRENA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
450 RACETRACK RD, MCDONOUGH, GA 30252-6837
(770) 305-9881
(678) 565-4626
Mailing address
PO BOX 123, MCDONOUGH, GA 30253-0123
(770) 305-9881
(678) 565-4626
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
CSW004250
GA
Other
Enumeration date
10/25/2010
Last updated
10/25/2010
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