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1225574759
FREDERICK JACKSON
CONCORD, CA
NPI
1225574759
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: CA R1239870916)
Enumeration Date
2017-01-08
Last Update Date
2017-01-08
Business Address
-- FREDERICK JACKSON
2090 COMMERCE AVE
CONCORD, CA 94520-4902
Phone number: 925-676-2580
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Mailing Address
-- FREDERICK JACKSON
2090 COMMERCE AVE
CONCORD, CA 94520-4902
Phone number: 925-676-2580
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