Theldrina Latina Jackson

NPI #1104514603 in Watkinsville, Georgia

Provider Information

NPI Number: 1104514603
Entity Type: Individual
Name: Theldrina Latina Jackson
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Behavior Technician
Enumeration Date: Apr 24, 2023
Last Updated: Apr 24, 2023

Practice Location

Address: 1360 CADUCEUS WAY STE 101
City: Watkinsville
State: Georgia
ZIP Code: 30677-7300
Phone: (762) 499-3476

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Behavior Technician	106S00000X	Primary

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