DETRA L JACKSON

DALLAS, TX
NPI1558206359
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy172V00000X Community Health Worker
Additional Taxonomies172A00000X Driver
251S00000X Community/Behavioral Health
311ZA0620X Custodial Care Facility, Adult Care Home
315P00000X Intermediate Care Facility, Intellectual Disabilities
320800000X Community Based Residential Treatment Facility, Mental Illness
Enumeration Date2026-04-20
Last Update Date2026-04-20
Business Address
DETRA L JACKSON
1910 PACIFIC AVE STE 20001046
DALLAS, TX 75201-4529
Phone number: 305-988-7335
Mailing Address
DETRA L JACKSON
1910 PACIFIC AVE STE 20001046
DALLAS, TX 75201-4529
Phone number: 305-988-7335