| NPI | 1720454499 |
|---|---|
| Former Name | MADELYN KATHLEEN JACKSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TN 7108) |
| Additional Taxonomies | 101Y00000X Counselor |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2015-08-18 |
| Last Update Date | 2024-09-20 |