THEO JACKSON

SANTA CRUZ, CA
NPI1083966261
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date2012-10-11
Last Update Date2012-10-11
Business Address
-- THEO JACKSON
200 7TH AVE
SANTA CRUZ, CA 95062-4668
Phone number: 831-462-1060
Mailing Address
-- THEO JACKSON
200 7TH AVE
SANTA CRUZ, CA 95062-4668
Phone number: 831-462-1060
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