Jalisa Jackson

NPI #1366041667 in Charlotte, North Carolina

Provider Information

NPI Number: 1366041667
Entity Type: Individual
Name: Jalisa Jackson
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Community Based Residential Treatment Facility, Mental Illness
Enumeration Date: Oct 19, 2020
Last Updated: Oct 19, 2020

Practice Location

Address: 11413 MANGLA DR
City: Charlotte
State: North Carolina
ZIP Code: 28214-8885
Phone: (704) 819-4909

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Community Based Residential Treatment Facility, Mental Illness	320800000X	Primary

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