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1124297692
GOVERNOR GILFORD JACKSON
MODESTO, CA
NPI
1124297692
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date
2008-02-28
Last Update Date
2021-10-05
Business Address
GOVERNOR GILFORD JACKSON
1235 MCHENRY AVE STE A&B
MODESTO, CA 95350-5370
Phone number: 209-527-4597
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Mailing Address
GOVERNOR GILFORD JACKSON
1235 MCHENRY AVE STE A&B
MODESTO, CA 95350-5370
Phone number: 209-527-4597
Copy
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