| NPI | 1518711829 |
|---|---|
| Former Legal Business Name | CRYSTAL R JACKSON HEALTHY LIFESTYLE LLC |
| Entity Type | Organization |
| Authorized Contact | CRYSTAL RENA JACKSON Professional Mental Health Counseor 215-601-7379 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Enumeration Date | 2024-04-15 |
| Last Update Date | 2024-07-19 |