JAISSEN M JACKSON

PROVIDENCE, RI
NPI1275074171
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy101YM0800X Counselor, Mental Health
(Licence: RI  MHC01094)
Additional Taxonomies101Y00000X Counselor
Enumeration Date2017-03-13
Last Update Date2019-10-23
Business Address
Mr. JAISSEN M JACKSON
194 WEBSTER AVE
PROVIDENCE, RI 02909-3818
Phone number: 401-261-0321
Mailing Address
Mr. JAISSEN M JACKSON
530 N MAIN ST
PROVIDENCE, RI 02904-5762
Phone number: 401-276-4100
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