Individual
EBONY CONERLY JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW, BACS
Contact information
Practice address
23791 SOUTHPOINT DR, DENHAM SPRINGS, LA 70726-6856
(225) 284-6249
Mailing address
23791 SOUTHPOINT DR, DENHAM SPRINGS, LA 70726-6856
(225) 284-6249
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
9158
LA
Other
Enumeration date
07/27/2015
Last updated
07/27/2015
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