Organization
EBONY C JACKSON LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS EBONY CONERLY JACKSON LCSW, BACS (SOCIAL WORKER)
(225) 284-6249
Entity
Organization
Contact information
Practice address
23791 SOUTHPOINT DR, DENHAM SPRINGS, LA 70726-6856
(225) 369-2617
Mailing address
23791 SOUTHPOINT DR, DENHAM SPRINGS, LA 70726-6856
(225) 369-2617
Taxonomy
Speciality
Code
Description
License number
State
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
9158
LA
Other
Enumeration date
06/23/2015
Last updated
06/23/2015
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