Individual
LETETA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
1 FREEDOM WAY, AUGUSTA, GA 30904-6258
(706) 733-0188
Mailing address
411 YORK LN, AUGUSTA, GA 30909-6089
(706) 825-3932
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
MSW006179
GA
Other
Enumeration date
05/30/2019
Last updated
05/30/2019
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