Individual
TIFFANY KRYSTAL JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2319 SAINT MATTHEWS RD, ORANGEBURG, SC 29118-2042
(803) 536-1571
Mailing address
2319 SAINT MATTHEWS RD, ORANGEBURG, SC 29118-2042
(803) 536-1571
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
413093
—
SC
Enumeration date
10/11/2012
Last updated
10/11/2012
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