| NPI | 1043729866 |
|---|---|
| Former Name | DANIELLE JACKSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MA 13527) |
| Additional Taxonomies | 101Y00000X Counselor |
| Enumeration Date | 2017-09-25 |
| Last Update Date | 2025-03-03 |