Individual
MRS. QUE'ANA LACHE MORRIS JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
931 MONROE DR NE STE A102-450, ATLANTA, GA 30308-1793
(404) 789-4079
(877) 833-3855
Mailing address
PO BOX 16294, ATLANTA, GA 30321-0294
(404) 789-4079
Taxonomy
Speciality
Code
Description
License number
State
102X00000X
Poetry Therapist
—
—
171M00000X
Case Manager/Care Coordinator
—
—
172A00000X
Driver
—
—
172V00000X
Community Health Worker
Primary
—
—
174H00000X
Health Educator
—
—
175F00000X
Naturopath
—
—
372500000X
Chore Provider
—
—
372600000X
Adult Companion
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1972856805
—
GA
Enumeration date
10/16/2012
Last updated
04/03/2019
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