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1427627744
EARLY LEE JACKSON
EUCLID, OH
NPI
1427627744
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: OH 175805)
Enumeration Date
2021-06-21
Last Update Date
2021-06-21
Business Address
EARLY LEE JACKSON
22639 EUCLID AVE
EUCLID, OH 44117-1622
Phone number: 216-404-1900
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Mailing Address
EARLY LEE JACKSON
6137 EDWARD ST APT 202
NORFOLK, VA 23513-1575
Phone number: 610-226-7670
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