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1689011983
JOSEPH RAY JACKSON
BELLEVILLE, IL
NPI
1689011983
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date
2013-05-28
Last Update Date
2013-05-28
Business Address
Mr. JOSEPH RAY JACKSON M.A.
12 N 64TH ST
BELLEVILLE, IL 62223-3809
Phone number: 618-397-0900
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Mailing Address
Mr. JOSEPH RAY JACKSON M.A.
12 N 64TH ST
BELLEVILLE, IL 62223-3809
Phone number: 618-397-0900
Copy
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