| NPI | 1174144646 |
|---|---|
| Former Name | CHRISTINE ELISE JACKSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6401012053) |
| Additional Taxonomies | 101YS0200X Counselor, School (Licence: MI IF0000000336251) |
| Enumeration Date | 2020-05-06 |
| Last Update Date | 2020-05-06 |