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1942745823
RAVEN JACKSON
MONROE, LA
NPI
1942745823
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
171M00000X Case Manager/Care Coordinator
Additional Taxonomies
101YM0800X Counselor, Mental Health
Enumeration Date
2016-12-30
Last Update Date
2018-06-08
Business Address
RAVEN JACKSON
4951 CENTRAL AVENUE
MONROE, LA 71203
Phone number: 318-340-1535
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Mailing Address
RAVEN JACKSON
850 KALISTE SALOOM RD STE 117
LAFAYETTE, LA 70508-4230
Phone number: 337-234-7109
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