Jackson, Jalisa

Jackson, Jalisa is an sole proprietor health care provider with primary practice located at 11413 Mangla Dr , Charlotte NC 28214-8885. She recently has only one registered license in Residential Treatment Facilities / Community Based Residential Treatment Facility, Mental Illness, which is considered as her primary health care specialty. Jackson, Jalisa can be contacted via phone (704) 819-4909.

Contact Information

Primary practice address
11413 Mangla Dr Charlotte NC 28214-8885
Phone: (704) 819-4909
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Residential Treatment Facilities / Community Based Residential Treatment Facility, Mental Illness 320800000X MHL-036-348 North Carolina

Profile Details

NPI number 1366041667
LBN Legal business name Jackson, Jalisa
Credentials
Entity Individual
Sole proprietor 1 Yes
Enumeration date Oct 19th, 2020
Last updated Oct 19th, 2020 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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