Healthcare Provider Details

I. General information

NPI: 1326531294
Provider Name (Legal Business Name): APRIL A JACKSON TLLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2018
Last Update Date: 06/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24211 FARMINGTON ROAD
FARMINGTON HILLS MI
48336
US

IV. Provider business mailing address

24211 FARMINGTON ROAD
FARMINGTON HILLS MI
48336
US

V. Phone/Fax

Practice location:
  • Phone: 248-416-9039
  • Fax:
Mailing address:
  • Phone: 248-416-9039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6301015362
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: