| NPI | 1164785689 |
|---|---|
| Former Name | SHONTIA VASH'E JACKSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: MS 1328) |
| Additional Taxonomies | 101YS0200X Counselor School (Licence: MS 198544) |
| Enumeration Date | 2012-06-19 |
| Last Update Date | 2012-06-20 |