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1083966261
THEO JACKSON
SANTA CRUZ, CA
NPI
1083966261
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date
2012-10-11
Last Update Date
2012-10-11
Business Address
-- THEO JACKSON
200 7TH AVE
SANTA CRUZ, CA 95062-4668
Phone number: 831-462-1060
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Mailing Address
-- THEO JACKSON
200 7TH AVE
SANTA CRUZ, CA 95062-4668
Phone number: 831-462-1060
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