| NPI | 1952837478 |
|---|---|
| Doing Business As | BEVERLY JACKSON |
| Entity Type | Organization |
| Authorized Contact | BEVERLY JACKSON Owner 813-434-3705 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2017-05-03 |
| Last Update Date | 2017-05-03 |