STANFORD JACKSON

LONG BEACH, CA
NPI1154668671
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: CA  123332 II)
Enumeration Date2013-01-04
Last Update Date2013-01-04
Business Address
-- STANFORD JACKSON CATCII
2008 PACIFIC AVE
LONG BEACH, CA 90806-4610
Phone number: 562-591-0011
Mailing Address
-- STANFORD JACKSON CATCII
1763 PINE AVE
LONG BEACH, CA 90813-1823
Phone number: 562-253-6594
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