NPI 1366041667
Jalisa Jackson
Practice location
- Address
- 11413 Mangla Dr, Charlotte, NC 28214-8885
- Phone
- (704) 819-4909
Registered specialties
Mental Illness Community Based Residential Treatment Facility
Primary
Registry record
- NPI
- 1366041667
- Entity type
- Individual
- Sex (as registered)
- Female
- NPI issued
- 19 Oct 2020
- Record last updated
- 19 Oct 2020
Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.