| NPI | 1316164924 |
|---|---|
| Former Name | STACIA LENNETTE JACKSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C006185) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MD G11976) |
| 1041C0700X Social Worker, Clinical (Licence: NC P003952) | |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2017-11-30 |