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1265096994
DERRICK JACK
NEW ALBANY, IN
NPI
1265096994
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
104100000X Social Worker
(Licence: IN 33008477A)
Enumeration Date
2019-04-29
Last Update Date
2019-04-29
Business Address
DERRICK JACK LSW
2627 CHARLESTOWN RD
NEW ALBANY, IN 47150-2536
Phone number: 812-944-1550
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Mailing Address
DERRICK JACK LSW
2008 ELDER PARK RD
LA GRANGE, KY 40031-9302
Phone number:
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