Individual
CLARISSA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
10140 HAWKEYE DR, CHARLOTTE, NC 28273-4536
(704) 458-8110
Mailing address
10140 HAWKEYE DR, CHARLOTTE, NC 28273-4536
(704) 458-8110
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
NC
Other
Enumeration date
09/20/2020
Last updated
09/20/2020
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