Individual
DAREL JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
16 W LONG ST, COLUMBUS, OH 43215-2815
(614) 809-1393
Mailing address
16 W LONG ST, COLUMBUS, OH 43215-2815
(614) 809-1393
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
CDCA.175418
OH
Other
Enumeration date
10/04/2021
Last updated
10/04/2021
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