Individual
JOSEPHINA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1611 CENTRAL AVE NW, ALBUQUERQUE, NM 87104-1139
(505) 247-4622
Mailing address
1611 CENTRAL AVE NW, ALBUQUERQUE, NM 87104-1139
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
0106471
NM
Other
Enumeration date
11/15/2012
Last updated
11/15/2012
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