Individual
THOMASENE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LLPC
Contact information
Practice address
9315 TELEGRAPH RD, REDFORD, MI 48239-1260
(313) 937-9500
(313) 937-9504
Mailing address
9329 TELEGRAPH RD, REDFORD, MI 48239-1260
(313) 937-9500
(313) 937-9504
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
6401013156
MI
101YP2500X
Professional Counselor
6401013156
MI
Other
Enumeration date
10/14/2013
Last updated
04/13/2022
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