Individual
ANITA DENISE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, LBSW
Contact information
Practice address
9315 TELEGRAPH RD, REDFORD, MI 48239-1260
(313) 450-4500
(313) 450-4512
Mailing address
9315 TELEGRAPH RD, REDFORD, MI 48239-1260
(313) 450-4500
(313) 450-4512
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
6802074632
MI
1041C0700X
Clinical Social Worker
6802074632
MI
Other
Enumeration date
03/19/2015
Last updated
03/21/2022
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