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1164845400
KEVIN JACKSON
SAN BERNARDINO, CA
NPI
1164845400
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date
2014-01-22
Last Update Date
2020-01-14
Business Address
KEVIN JACKSON
621 E CARNAGIE DR # 210 SAN BERNARDINO CA 92415
SAN BERNARDINO, CA 92415-3919
Phone number: 909-386-9767
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Mailing Address
KEVIN JACKSON
621 E CARNAGIE DR # 210 SAN BERNARDINO CA 92415
SAN BERNARDINO, CA 92415-0530
Phone number: 909-386-9767
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