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1326469123
ALYCIA JACKSON
SAN BERNARDINO, CA
NPI
1326469123
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date
2013-12-20
Last Update Date
2013-12-20
Business Address
Ms. ALYCIA JACKSON
1963 N E ST
SAN BERNARDINO, CA 92405-3919
Phone number: 909-881-6146
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Mailing Address
Ms. ALYCIA JACKSON
1963 N E ST
SAN BERNARDINO, CA 92405-3919
Phone number: 909-881-6146
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