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1821774001
JACKSON BLANTON
IRMO, SC
NPI
1821774001
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
106S00000X Behavior Technician
(Licence: SC RBT-23-279488)
Enumeration Date
2023-06-23
Last Update Date
2023-06-23
Business Address
JACKSON BLANTON
1084 LAKE MURRAY BLVD
IRMO, SC 29063-2821
Phone number: 706-842-5330
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Mailing Address
JACKSON BLANTON
PO BOX 2567
AUGUSTA, GA 30903-2567
Phone number: 706-842-5330
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