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1477700706
JACKIE DISPO
VALLEJO, CA
NPI
1477700706
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date
2008-08-18
Last Update Date
2008-08-18
Business Address
-- JACKIE DISPO
301 GEORGIA ST
VALLEJO, CA 94590-5946
Phone number: 707-558-8195
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Mailing Address
-- JACKIE DISPO
301 GEORGIA ST
VALLEJO, CA 94590-5946
Phone number: 707-558-8195
Copy
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