Individual
BREYANA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1316 S MEADOW LN APT 221, COLTON, CA 92324-6420
(323) 921-4343
Mailing address
1316 S MEADOW LN APT 221, COLTON, CA 92324-6420
(323) 921-4343
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
73138
CA
Other
Enumeration date
10/20/2016
Last updated
10/20/2016
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