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General NPI Number Information
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NPI Number | 1518618354
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Entity Type | Organization
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Legal Business Name | LATOSHA JACKSON LLC
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Dates
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Enumeration Date | 01/13/2022
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Last Update Date | 01/13/2022
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Provider Practice Location Address
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Address Line | 6 CHENELL DR STE 100
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City | CONCORD
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State | NH
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Zip | 03301-8514
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Country | US
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Telephone | 603-545-8355
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Fax |
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Provider Business Mailing Address
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Address Line | 1 HARDY RD # 128
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City | BEDFORD
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State | NH
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Zip | 03110-4915
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PROVIDER
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Name | LATOSHA JACKSON
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Credential | LICSW
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Telephone | 402-469-6899
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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