Individual
MARIBEL JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3484 CEDARCREST AVE APT 1302, BATON ROUGE, LA 70816-2095
(225) 614-7166
Mailing address
3484 CEDARCREST AVE APT 1302, BATON ROUGE, LA 70816-2095
(225) 614-7166
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
LA
171M00000X
Case Manager/Care Coordinator
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0000
—
LA
Enumeration date
10/25/2017
Last updated
06/16/2018
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