Individual provider · Type 1 NPI
Kenneth T. Jackson, MASTERS
Addiction (Substance Use Disorder) Counselor · Warren, MI
NPI number
1639469026
Active
Practice location
25506 Virginia Dr
Warren, MI 48091-6002
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Addiction (Substance Use Disorder) Counselor Primary | 101YA0400X | None listed |
Addiction (Substance Use Disorder) Counselor: Definition to come...
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About NPI 1639469026
Kenneth T. Jackson, MASTERS's National Provider Identifier is 1639469026, issued on Apr 19, 2011. The primary taxonomy on file is Addiction (Substance Use Disorder) Counselor (101YA0400X), and the practice location is in Warren, MI. The record was last updated on Apr 19, 2011.