| NPI | 1124759675 |
|---|---|
| Former Name | JANET RENEE JACKSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TN 1128) |
| Enumeration Date | 2022-06-23 |
| Last Update Date | 2022-06-23 |