ULYSSES JACKSON

DEER PARK, NY
NPI1376962647
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy101YA0400X Counselor Addiction (Substance Use Disorder)
(Licence: NY  24980)
Enumeration Date2014-04-15
Last Update Date2014-04-15
Business Address
ULYSSES JACKSON
770 GRAND BLVD
DEER PARK, NY 11729-5750
Phone number: 631-392-4357
Mailing Address
ULYSSES JACKSON
770 GRAND BLVD
DEER PARK, NY 11729-5750
Phone number: 631-392-4357
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