Individual
MS. CAMILLA VAWN JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMFT, LPC
Contact information
Practice address
1006 GUADALUPE ST APT 5C, KERRVILLE, TX 78028-4915
(830) 496-1419
Mailing address
1006 GUADALUPE STREET #5C, KERRVILLE, TX 78028
(713) 240-4433
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
18405
TX
106H00000X
Marriage & Family Therapist
Primary
4732
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1841335916
NPI
TX
Enumeration date
02/20/2007
Last updated
04/04/2022
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