GOVERNOR JACKSON
Counselor - Addiction (Substance Use Disorder)
Active
Individual
NPI: 1124297692
Specialties
| Specialty | Code | Primary | License |
|---|---|---|---|
| Counselor - Addiction (Substance Use Disorder) | 101YA0400X | Yes | - |
Frequently Asked Questions
NPI 1124297692 is the National Provider Identifier for GOVERNOR JACKSON, a Counselor - Addiction (Substance Use Disorder) provider located in Modesto, CA. This NPI was enumerated on February 28, 2008.
GOVERNOR JACKSON practices at 1235 MCHENRY AVE STE A&B, Modesto, CA 95350.
Quick Facts
- NPI
- 1124297692
- Type
- Individual
- Enumerated
- Feb 28, 2008
- Last Updated
- Oct 5, 2021
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