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Individual

AVIS JACKSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
315 S COLLEGE RD, LAFAYETTE, LA 70503-3212
(337) 572-9844
Mailing address
9487 BROOKLINE AVE, BATON ROUGE, LA 70809-1429

Taxonomy

Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
PLC8960
LA
101YP2500X
Professional Counselor
LA
171M00000X
Case Manager/Care Coordinator

Other

Enumeration date
02/12/2020
Last updated
06/07/2024
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