| NPI | 1912771361 |
|---|---|
| Former Name | TILA JACKSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 55581) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2023-11-07 |
| Last Update Date | 2023-11-07 |