Individual
LATOYA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS,QP
Contact information
Practice address
5041 NEW CENTRE DR STE 209, WILMINGTON, NC 28403-1624
(910) 392-8956
Mailing address
19 HOLLAND DR, CASTLE HAYNE, NC 28429-5914
(313) 468-7794
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
05/22/2007
Last updated
06/21/2011
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