Individual
NATASHA V JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
180 SHEPPARD RD STE 115, JACKSON, MS 39206-4033
(601) 813-6141
Mailing address
455 CROSSGATES BLVD APT 226, BRANDON, MS 39042-2560
(601) 813-6141
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
C8125
MS
1041C0700X
Clinical Social Worker
C8125
MS
Other
Enumeration date
02/28/2013
Last updated
03/17/2018
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