GOVERNOR GILFORD JACKSON

MODESTO, CA
NPI1124297692
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date2008-02-28
Last Update Date2021-10-05
Business Address
GOVERNOR GILFORD JACKSON
1235 MCHENRY AVE STE A&B
MODESTO, CA 95350-5370
Phone number: 209-527-4597
Mailing Address
GOVERNOR GILFORD JACKSON
1235 MCHENRY AVE STE A&B
MODESTO, CA 95350-5370
Phone number: 209-527-4597
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