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Individual
MS. MICHELE DENISE JACKSON
Active
Individual
MS. MICHELE DENISE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RI-J0808181554
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
RI-J808181554
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
941702064
ALCOHOL AND OTHER DRUG
CA
Enumeration date
07/27/2009
Last updated
07/27/2009
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