Individual
MS. REGINA MICHELLE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
2090 BAKER RD NW STE 304-160, KENNESAW, GA 30144-4600
(770) 693-0817
Mailing address
2090 BAKER RD NW STE 304-160, KENNESAW, GA 30144-4600
(770) 693-0817
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
CSW008800
GA
104100000X
Social Worker
Primary
MSW006356
GA
Other
Enumeration date
08/02/2022
Last updated
03/07/2026
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