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1467134544
TERRANCE LAMONT JACKSON
CANTON, OH
NPI
1467134544
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
305S00000X Point of Service
Additional Taxonomies
101Y00000X Counselor
Enumeration Date
2023-08-07
Last Update Date
2023-08-07
Business Address
TERRANCE LAMONT JACKSON
2155 GEORGETOWN RD NE
CANTON, OH 44704-2257
Phone number: 816-377-7225
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Mailing Address
TERRANCE LAMONT JACKSON
2155 GEORGETOWN RD NE
CANTON, OH 44704-2257
Phone number: 816-377-7225
Copy