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1831965177
SHALYSE A JACKSON
MONROE, LA
NPI
1831965177
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date
2023-11-28
Last Update Date
2023-11-28
Business Address
SHALYSE A JACKSON
2101 TOWER DR
MONROE, LA 71201-5045
Phone number: 318-323-1300
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Mailing Address
SHALYSE A JACKSON
2101 TOWER DR
MONROE, LA 71201-5045
Phone number: 318-323-1300
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