Individual
LILLY MAE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
209 S LOCKARD ST, BLYTHEVILLE, AR 72315-2541
(870) 763-2139
Mailing address
2707 BROWNS LN, JONESBORO, AR 72401-7213
(870) 972-4939
(871) 972-4911
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
2598-M
AR
Other
Enumeration date
07/18/2011
Last updated
11/02/2023
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