Individual
MAYQUIE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
103 BOULEVARD ST, SHREVEPORT, LA 71104-2503
(318) 895-6106
Mailing address
103 BOULEVARD ST, SHREVEPORT, LA 71104-2503
(318) 895-6106
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
LA
Other
Enumeration date
01/25/2023
Last updated
01/25/2023
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