Search › Minnesota › 101YM0800X
Antoine Jackson, MA, LPCC
NPI 1174278048 · on the registry since 2022 · sole proprietor
Practice
- Address
- 2335 Woodbridge St Apt 338
Roseville, MN 55113 - Phone
- (612) 715-4071
- Organisation at this address
- Supportive Change Counseling & Consulting
Inferred from a shared address, not stated in the registry.
Registry record
- Primary taxonomy
- 101YM0800X
101YM0800X
- Licence states on file
- MN
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2024-11-14
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Minnesota