| NPI | 1962858050 |
|---|---|
| Former Name | KIMBERLY JACKSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: LA 10088) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: LA 10088) |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2016-05-09 |
| Last Update Date | 2024-05-01 |