| NPI | 1336502152 |
|---|---|
| Former Name | MALLARY JACKSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| Enumeration Date | 2016-03-30 |
| Last Update Date | 2022-10-27 |