Individual
MISS NICOLE SHELIE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S.
Contact information
Practice address
2100 COMER AVE, COLUMBUS, GA 31904-8725
(706) 596-5764
Mailing address
317 14TH AVE, PHENIX CITY, AL 36869-6951
(334) 480-0489
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
05/22/2007
Last updated
07/08/2007
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