| NPI | 1285853481 |
|---|---|
| Other Name | TERREL JACKSON |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL 3282) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL MH8379) |
| Enumeration Date | 2007-04-25 |
| Last Update Date | 2007-07-08 |