Individual
TRACEY ANN JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LBSW
Contact information
Practice address
1547 PARKWAY STE 100, GREENWOOD, SC 29646-4081
(864) 229-7120
Mailing address
2413 CEDAR SPGS S, ABBEVILLE, SC 29620-6246
(864) 446-3407
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
421504
—
SC
Enumeration date
10/02/2008
Last updated
10/02/2008
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