| Ebony C Jackson Llc | |
|
23791 Southpoint Dr Denham Springs LA 70726-6856 | |
| (225) 369-2617 | |
| Not Available |
| Full Name | Ebony C Jackson Llc |
|---|---|
| Speciality | Clinic/center - Adolescent And Children Mental Health |
| Location | 23791 Southpoint Dr, Denham Springs, Louisiana |
| Authorized Official Name and Position | Ebony Conerly Jackson (SOCIAL WORKER) |
| Authorized Official Contact | 2252846249 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ebony C Jackson Llc 23791 Southpoint Dr Denham Springs LA 70726-6856 Ph: (225) 369-2617 | Ebony C Jackson Llc 23791 Southpoint Dr Denham Springs LA 70726-6856 Ph: (225) 369-2617 |
| NPI Number | 1821470188 |
|---|---|
| Provider Enumeration Date | 06/23/2015 |
| Last Update Date | 06/23/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821470188 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | 9158 (Louisiana) | Primary |
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