Individual
ASHANTI JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S., M.ED.
Contact information
Practice address
2924 KNIGHT ST STE 426, SHREVEPORT, LA 71105-2414
(318) 754-3560
Mailing address
PO BOX 342, BETHANY, LA 71007-0342
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
171M00000X
Case Manager/Care Coordinator
Primary
—
LA
Other
Enumeration date
05/04/2017
Last updated
04/25/2018
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