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1366631590
CARNELL JACKSON
LOS ANGELES, CA
NPI
1366631590
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date
2007-10-24
Last Update Date
2007-10-24
Business Address
-- CARNELL JACKSON
2918 W VERNON AVE
LOS ANGELES, CA 90008-4757
Phone number: 323-497-8150
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Mailing Address
-- CARNELL JACKSON
2918 W VERNON AVE
LOS ANGELES, CA 90008-4757
Phone number: 323-497-8150
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