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1760850192
MICHAEL JACKSON
SAN FRANCISCO, CA
NPI
1760850192
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: CA 154980I)
Enumeration Date
2015-09-02
Last Update Date
2015-09-02
Business Address
-- MICHAEL JACKSON
815 BUENA VISTA AVE W
SAN FRANCISCO, CA 94117-4108
Phone number: 415-554-1450
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Mailing Address
-- MICHAEL JACKSON
815 BUENA VISTA AVE W
SAN FRANCISCO, CA 94117-4108
Phone number: 415-554-1450
Copy
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