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1013143395
WILLIE LEE JACKSON
LOS ANGELES, CA
NPI
1013143395
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date
2009-06-01
Last Update Date
2009-06-01
Business Address
-- WILLIE LEE JACKSON
157 SANTA BARBARA PLZ
LOS ANGELES, CA 90008-2508
Phone number: 323-293-2717
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Mailing Address
-- WILLIE LEE JACKSON
157 SANTA BARBARA PLZ
LOS ANGELES, CA 90008-2508
Phone number: 323-293-2717
Copy
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