Individual
CATHERINE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
418 NEW GOFF MOUNTAIN RD STE 201, CROSS LANES, WV 25313-1488
(304) 755-9411
Mailing address
418 NEW GOFF MOUNTAIN RD STE 201, CROSS LANES, WV 25313-1488
(304) 755-9411
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
WV
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
12/21/2020
Last updated
12/21/2020
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