Individual
MISS TAKIRA C. JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LAC
Contact information
Practice address
14413 S 47TH PL, PHOENIX, AZ 85044-6215
(716) 400-2465
Mailing address
14413 S 47TH PL, PHOENIX, AZ 85044-6215
(716) 400-2465
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
LAC-21216
AZ
Other
Enumeration date
09/05/2022
Last updated
09/05/2022
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