EARLY LEE JACKSON

EUCLID, OH
NPI1427627744
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy101YA0400X Counselor Addiction (Substance Use Disorder)
(Licence: OH  175805)
Enumeration Date2021-06-21
Last Update Date2021-06-21
Business Address
EARLY LEE JACKSON
22639 EUCLID AVE
EUCLID, OH 44117-1622
Phone number: 216-404-1900
Mailing Address
EARLY LEE JACKSON
6137 EDWARD ST APT 202
NORFOLK, VA 23513-1575
Phone number: 610-226-7670
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