Individual
MRS. DREATHA JEAN JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, LPC, NCC
Contact information
Practice address
6032 PONTCHARTRAIN BLVD, NEW ORLEANS, LA 70124-1934
(618) 623-9771
Mailing address
406 LINDEN AVE, CENTRALIA, IL 62801-4329
(618) 623-9771
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
6130
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
495864803
—
MO
05
—
495864829
—
MO
Enumeration date
11/29/2006
Last updated
03/26/2020
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