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1972383792
JAXON MARCEL GRANDCHAMP
SACRAMENTO, CA
NPI
1972383792
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: CA 12856)
Enumeration Date
2023-09-29
Last Update Date
2023-09-29
Business Address
JAXON MARCEL GRANDCHAMP SUDRC
2100 CAPITOL AVE
SACRAMENTO, CA 95816-5721
Phone number: 916-442-4985
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Mailing Address
JAXON MARCEL GRANDCHAMP SUDRC
2100 CAPITOL AVE
SACRAMENTO, CA 95816-5721
Phone number: 916-442-4985
Copy
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