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Organization
KEYSTONE DJJ, LLC
Active
Organization
KEYSTONE DJJ, LLC
Active
Other names
Bristol Youth Academy
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JEANETTE JACKSON LCSW (PROGRAM DIRECTOR)
(850) 643-4600
Entity
Organization
Contact information
Practice address
12422 NW G T REVELL RD, BRISTOL, FL 32321-3007
(850) 643-4600
(850) 643-2061
Mailing address
12422 NW G T REVELL RD, BRISTOL, FL 32321-3007
(850) 643-4600
(850) 643-2061
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0239AD272501
OUTPATIENT SUBSTANCE ABUS
FL
Enumeration date
11/05/2007
Last updated
06/14/2008
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