Individual
JADE RAVEN JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
720 SAINT JOHN ST, LAFAYETTE, LA 70501-6706
(337) 237-2090
Mailing address
104 MANN DR, LAFAYETTE, LA 70506-1621
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
PLC11226
LA
Other
Enumeration date
05/19/2026
Last updated
05/19/2026
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