Individual
CAROL JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LISW - S, LICDC
Contact information
Practice address
1100 N COLLEGE AVE, FAYETTEVILLE, AR 72703-1944
(479) 444-4044
Mailing address
4500 S LANCASTER RD, DALLAS, TX 75216-7167
(214) 742-8387
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
I 0028219
OH
Other
Enumeration date
06/07/2007
Last updated
05/26/2015
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