Individual
MARK MONROE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MSW
Contact information
Practice address
119 KONA DR, GALVESTON, TX 77554-8623
(409) 354-1838
(409) 935-9193
Mailing address
119 KONA DR, GALVESTON, TX 77554-8623
(409) 354-1838
(409) 935-9193
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
52697
TX
Other
Enumeration date
08/05/2011
Last updated
08/05/2011
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