Individual
ANNIE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4616 NORTHAVEN DR, CHARLOTTE, NC 28206-1730
(704) 597-8370
Mailing address
4616 NORTHAVEN DR, CHARLOTTE, NC 28206-1730
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
412
NC
101YP1600X
Pastoral Counselor
—
NC
Other
Enumeration date
10/18/2010
Last updated
10/18/2010
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