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1003597071
PHILIP JACKSON
LOS ANGELES, CA
NPI
1003597071
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date
2023-07-31
Last Update Date
2023-07-31
Business Address
PHILIP JACKSON
360 S WESTLAKE AVE
LOS ANGELES, CA 90057-2906
Phone number: 213-483-9201
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Mailing Address
PHILIP JACKSON
360 S WESTLAKE AVE
LOS ANGELES, CA 90057-2906
Phone number: 213-483-9201
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