Individual
MELISSA M JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
2715 BULLIS AVE, GULFPORT, MS 39501-5233
(228) 697-3953
Mailing address
2715 BULLIS AVE, GULFPORT, MS 39501-5233
(228) 697-3953
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
C10824
MS
Other
Enumeration date
12/27/2023
Last updated
01/10/2025
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