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1124449053
SANDRA J JACKSON
SOUTH BEND, IN
NPI
1124449053
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: IN 88000353A)
Enumeration Date
2013-12-19
Last Update Date
2013-12-19
Business Address
Ms. SANDRA J JACKSON LCAC CADAC IV NADAC
4218 WESTERN AVE.
SOUTH BEND, IN 46619
Phone number: 574-233-1524
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Mailing Address
Ms. SANDRA J JACKSON LCAC CADAC IV NADAC
4218 WESTERN AVE.
SOUTH BEND, IN 46619
Phone number: 574-274-1524
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