STACI NICOLE JACKSON

BATON ROUGE, LA
NPI1003329160
Entity TypeIndividual
GenderFemale
Sole Proprietor ?Yes
Primary Taxonomy101YM0800X Counselor, Mental Health
Enumeration Date2017-11-13
Last Update Date2017-11-13
Business Address
STACI NICOLE JACKSON
11616 SOUTHFORK AVE
BATON ROUGE, LA 70816-5241
Phone number: 225-291-9646
Mailing Address
STACI NICOLE JACKSON
11616 SOUTHFORK AVE
BATON ROUGE, LA 70816-5241
Phone number: 225-291-9646
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