BLAIRE JACKSON

TAMPA, FL
NPI1245599547
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: LA  CAC 1335)
Enumeration Date2012-05-08
Last Update Date2015-07-14
Business Address
Mr. BLAIRE JACKSON CAC
5707 N 22ND ST
TAMPA, FL 33610-4350
Phone number: 813-239-8069
Mailing Address
Mr. BLAIRE JACKSON CAC
5707 N 22ND ST
TAMPA, FL 33610-4350
Phone number: 813-239-8069
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