Provider Demographics
NPI:1013605377
Name:JACKSON GARRAND, SALISA
Entity Type:Individual
Prefix:
First Name:SALISA
Middle Name:
Last Name:JACKSON GARRAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 CINNAMON RDG
Mailing Address - Street 2:
Mailing Address - City:KEESEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12944-2642
Mailing Address - Country:US
Mailing Address - Phone:908-547-9219
Mailing Address - Fax:
Practice Address - Street 1:586 PRESIDENT ST APT 6D
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-1392
Practice Address - Country:US
Practice Address - Phone:917-709-2927
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-25
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor