Individual
MS. ALFAYE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PLPC
Contact information
Practice address
104 FOX CREEK RD, ROLLA, MO 65401-3620
(417) 693-2770
Mailing address
104 FOX CREEK RD, ROLLA, MO 65401-3620
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
2008015070
MO
101YP2500X
Professional Counselor
Primary
2015044726
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
490047336
—
MO
Enumeration date
08/07/2008
Last updated
11/21/2022
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