Individual
LATISHA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMHC
Contact information
Practice address
2201 E 46TH ST STE 108, INDIANAPOLIS, IN 46205-1449
(317) 561-0390
Mailing address
2201 E 46TH ST STE 108, INDIANAPOLIS, IN 46205-1449
(317) 561-0390
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
39005380A
IN
Other
Enumeration date
09/27/2018
Last updated
07/24/2025
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