| NPI | 1124476510 |
|---|---|
| Former Name | SANDRA SABRINA JACKSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: SC 8841) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: SC 8841) |
| 101YP2500X Counselor, Professional (Licence: SC 8841) | |
| Enumeration Date | 2016-05-26 |
| Last Update Date | 2023-08-04 |