Individual
MR. WOMBLE JACKSON JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2003 FRANKLIN AVE, RUSTON, LA 71270-9661
(318) 331-3977
(318) 224-9056
Mailing address
2003 FRANKLIN AVE, RUSTON, LA 71270-9661
(318) 331-3977
(318) 224-9056
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
343900000X
Non-emergency Medical Transport (VAN)
—
—
Other
Enumeration date
05/08/2020
Last updated
08/26/2025
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