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1053546184
CAROLE INA JACKSON
TAOS, NM
NPI
1053546184
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
101YM0800X Counselor Mental Health
(Licence: NM 0132791)
Enumeration Date
2009-05-19
Last Update Date
2012-11-28
Business Address
MS. CAROLE INA JACKSON LPCC
1337 GUSDORF ROAD SUITE E
TAOS, NM 87571
Phone number: 575-758-4297
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Mailing Address
MS. CAROLE INA JACKSON LPCC
PO BOX 237
EL PRADO, NM 87529-0237
Phone number: 575-776-2620
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