CHARLES JACKSON

SHREVEPORT, LA
NPI1457896839
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy101YM0800X Counselor, Mental Health
Enumeration Date2016-12-21
Last Update Date2016-12-21
Business Address
-- CHARLES JACKSON
2911 PENICK ST
SHREVEPORT, LA 71109-4337
Phone number: 318-393-8396
Mailing Address
-- CHARLES JACKSON
2911 PENICK ST
SHREVEPORT, LA 71109-4337
Phone number: 318-393-8396
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