Individual
CHARLENE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5900 BALCONES DR STE 100, AUSTIN, TX 78731-4298
(337) 424-6841
Mailing address
5900 BALCONES DR STE 100, AUSTIN, TX 78731-4298
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
15426
TX
101YM0800X
Mental Health Counselor
Primary
81162
TX
101YP2500X
Professional Counselor
81162
TX
Other
Enumeration date
07/26/2021
Last updated
07/26/2021
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