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Individual
JESSE BENJAMIN FLACK
Active
Individual
JESSE BENJAMIN FLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CADC-I
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
21-04-10112
OR
Other
Enumeration date
06/11/2019
Last updated
10/04/2021
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