Individual
JOSEPH GRANVILLE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CCS, RAC
Contact information
Practice address
411 SPARROW ST, LAKE PROVIDENCE, LA 71254-3035
(318) 559-3356
(318) 559-2044
Mailing address
706 SPARROW ST, LAKE PROVIDENCE, LA 71254-3520
(318) 559-3356
(318) 559-2044
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
1300
LA
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
186
LA
Other
Enumeration date
01/22/2016
Last updated
01/22/2016
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