Individual provider · Type 1 NPI

Casiel Dominique Jackson, LAC

Mental Health Counselor · Mesa, AZ

NPI number 1487373130 Active

Practice location

1705 W Main St
Mesa, AZ 85201-6920

Mailing address

45464 W Long Way
Maricopa, AZ 85139-7074

Specialties and licenses

TaxonomyCodeLicense
Mental Health Counselor Primary 101YM0800XLAC-7258T (AZ)

Mental Health Counselor: Definition to come...

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About NPI 1487373130

Casiel Dominique Jackson, LAC's National Provider Identifier is 1487373130, issued on Aug 25, 2022. The primary taxonomy on file is Mental Health Counselor (101YM0800X), and the practice location is in Mesa, AZ. The record was last updated on Aug 25, 2022.