Most Relevant Information
Provider Data
| NPI Number: | 1003322827 |
| Provider Name: | SHANTA D JACKSON |
| Entity Type: | Individual |
| Taxonomy Code: | 101YM0800X |
| Specialty: | Counselor |
| License Number: | 73107 |
Most Important Dates
| Enumeration Date: | 12/15/2017 |
| Last Updated: | 08/20/2024 |
Provider Practice Location
445 E FM 1382 STE 3
CEDAR HILL
TX
751046046
Practice Location Phone/Fax
| Phone: | 2146997908 |
| Fax: |
Provider Mailing Location
445 E FM 1382 STE 3
CEDAR HILL
TX
751046046
Provider Mailing Phone/Fax
| Phone: | 9725231996 |
| Fax: |