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1366209264
AUDREY JACKSON
LAUREL, MS
NPI
1366209264
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
101YM0800X Counselor, Mental Health
(Licence: MS 5805)
Enumeration Date
2024-03-06
Last Update Date
2024-03-06
Business Address
AUDREY JACKSON PCNHT
1721 W 10TH ST
LAUREL, MS 39440-2540
Phone number: 601-425-9322
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Mailing Address
AUDREY JACKSON PCNHT
PO BOX 18679
HATTIESBURG, MS 39404-8679
Phone number: 601-705-1901
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