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 |