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1174278048
ANTOINE DESHAWN JACKSON
MINNEAPOLIS, MN
NPI
1174278048
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
101YM0800X Counselor, Mental Health
(Licence: MN 3145)
Enumeration Date
2022-02-18
Last Update Date
2022-02-18
Business Address
ANTOINE DESHAWN JACKSON MA, LPCC
2120 CLINTON AVE
MINNEAPOLIS, MN 55404-2649
Phone number: 612-871-0099
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Mailing Address
ANTOINE DESHAWN JACKSON MA, LPCC
2335 WOODBRIDGE ST APT 338
ROSEVILLE, MN 55113-4763
Phone number: 612-715-4071
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