Healthcare Provider Details

I. General information

NPI: 1447652359
Provider Name (Legal Business Name): JACINTA SHANAY JAMISON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2014
Last Update Date: 01/09/2026
Certification Date: 01/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 STUBBS AVE
MONROE LA
71201-5622
US

IV. Provider business mailing address

333 WOODALE DR UNIT 5
MONROE LA
71203-2791
US

V. Phone/Fax

Practice location:
  • Phone: 318-325-8748
  • Fax: 318-325-8749
Mailing address:
  • Phone: 318-362-3339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number9218
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: