LATISHA NICOLE JACKSON

RICHMOND, CA
NPI1548446537
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date2008-01-21
Last Update Date2008-02-05
Business Address
-- LATISHA NICOLE JACKSON
820 23RD ST
RICHMOND, CA 94804-1338
Phone number: 510-229-5000
Mailing Address
-- LATISHA NICOLE JACKSON
642 57TH ST
OAKLAND, CA 94609-1630
Phone number: 510-228-7412
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