| NPI | 1699969188 |
|---|---|
| Former Name | KIMBERLY ERIN JACKSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2007-08-28 |
| Last Update Date | 2022-12-17 |