Individual provider · Type 1 NPI

Kevin Jackson Sr.

Addiction (Substance Use Disorder) Counselor · San Bernardino, CA

NPI number 1164845400 Active

Practice location

621 E Carnagie Dr # 210 San Bernardino Ca 92415
San Bernardino, CA 92415-3919

Call (909) 386-9767 Map

Fax (909) 381-2172

Specialties and licenses

TaxonomyCodeLicense
Addiction (Substance Use Disorder) Counselor Primary 101YA0400XNone listed

Addiction (Substance Use Disorder) Counselor: Definition to come...

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About NPI 1164845400

Kevin Jackson Sr.'s National Provider Identifier is 1164845400, issued on Jan 22, 2014. The primary taxonomy on file is Addiction (Substance Use Disorder) Counselor (101YA0400X), and the practice location is in San Bernardino, CA. The record was last updated on Jan 14, 2020.