Individual
CRYSTAL JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
1035 CHERAW ST., BENNETTSVILLE, SC 29512
(843) 454-0442
(843) 454-0212
Mailing address
P.O. BOX 918, BENNETTSVILLE, SC 29512
(843) 454-0841
(843) 454-0635
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
405127
—
SC
Enumeration date
09/21/2009
Last updated
09/22/2009
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