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1053927723
IRENE DORMENIE JACKSON
DURHAM, NC
NPI
1053927723
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
101YA0400X Counselor Addiction (Substance Use Disorder)
(Licence: NC LCAS-26084)
Enumeration Date
2020-09-18
Last Update Date
2020-09-18
Business Address
IRENE DORMENIE JACKSON LCAS-A
904 WOODGREEN DR
DURHAM, NC 27704-6034
Phone number: 919-641-8358
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Mailing Address
IRENE DORMENIE JACKSON LCAS-A
904 WOODGREEN DR
DURHAM, NC 27704-6034
Phone number: 919-641-8358
Copy
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