Individual
MS. LATISHA SIMONE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
709 MALLOY ST, FLORENCE, SC 29506-6456
(843) 230-0540
Mailing address
709 MALLOY ST, FLORENCE, SC 29506-6456
(843) 230-0540
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
376241
—
SC
Enumeration date
04/11/2007
Last updated
01/20/2026
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