LATORIA NICOLE JACKSON

LOGANVILLE, GA
NPI1922500289
Entity TypeIndividual
GenderFemale
Sole Proprietor ?Yes
Primary Taxonomy343900000X Non-emergency Medical Transport (VAN)
Additional Taxonomies171M00000X Case Manager/Care Coordinator
251B00000X Case Management
251C00000X Day Training, Developmentally Disabled Services
251S00000X 
261QA0600X Clinic/Center, Adult Day Care
261QD1600X Clinic/Center, Developmental Disabilities
3104A0625X Assisted Living Facility, Assisted Living, Mental Illness
320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities
320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
372600000X Adult Companion
373H00000X Day Training/Habilitation Specialist
Enumeration Date2018-03-02
Last Update Date2018-03-02
Business Address
LATORIA NICOLE JACKSON
4150 ALEXIS CT
LOGANVILLE, GA 30052-9070
Phone number: 678-671-0078
Mailing Address
LATORIA NICOLE JACKSON
4150 ALEXIS CT
LOGANVILLE, GA 30052-9070
Phone number: 678-671-0078