Individual
KIMBERLY JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1705 FELICIA AVE, TALLULAH, LA 71282
(318) 574-1232
Mailing address
1705 FELICIA AVE, TALLULAH, LA 71282-8203
(318) 574-1232
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
10088
LA
101YM0800X
Mental Health Counselor
10088
LA
171M00000X
Case Manager/Care Coordinator
—
LA
Other
Enumeration date
05/09/2016
Last updated
10/29/2025
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