Individual
AMY JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
3590 MARY ADER AVE APT 1021, CHARLESTON, SC 29414-5792
(910) 712-0026
Mailing address
3590 MARY ADER AVE APT 1021, CHARLESTON, SC 29414-5792
(910) 712-0026
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
6391
SC
Other
Enumeration date
04/05/2017
Last updated
04/05/2017
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