| Doctor Name: | BREONKA MARIE JACKSON |
| NPI Number: | 1053774158 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 824 Elmwood Park Blvd Ste 150 Harahan, LA - 701233347 |
| Business Phone Number: | 5047338222 |
| Business Fax Number: | |
| Mailing Address: | 824 Elmwood Park Blvd, HARAHAN |
| State: | LA |
| Postal Code: | 701233360 |
| Phone Number: | 5042669708 |
| Fax Number: | |
| NPI Enumeration Date: | 04/05/2016 |
| NPI Last Update Date: | 04/05/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |