Individual
DLISA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
200 S BROAD ST STE 7, NEW ORLEANS, LA 70119-6447
(504) 205-3355
Mailing address
140 LEIGH LN, MONTZ, LA 70068-8968
(504) 205-3355
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
09/26/2018
Last updated
09/26/2018
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