Provider Information for 1366082752
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Ms. ALICIA (ALI) JACKSON LCSW
Other Names:Other Name:Ms. ALI JACKSON LCSWSex: Female
NPI: 1366082752
Last Updated: 2022-10-28
Certification Date: 2020-02-27
Certification Date: 2020-02-27
Details
| Name | Value | ||||||||
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| NPI | 1366082752 | ||||||||
| Enumeration Date | 2020-01-14 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 15507 VALLEY PLUM CT CYPRESS, TX 77433-6010 United States Phone: 281-652-7468 | Fax: | ||||||||
| Primary Practice Address | 15040 FAIRFIELD PLACE CYPRESS, TX United States Phone: 281-652-7468 | Fax: | ||||||||
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