JACK BLACKWELL

WOODLAND, CA
NPI1215574561
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date2019-12-05
Last Update Date2020-09-28
Business Address
JACK BLACKWELL RADT
215 W BEAMER ST
WOODLAND, CA 95695-2510
Phone number: 530-405-2815
Mailing Address
JACK BLACKWELL RADT
215 W BEAMER ST
WOODLAND, CA 95695-2510
Phone number: 530-405-2815
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