Individual
MR. ANDREW LEE JACKSON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
6355 RIVERSIDE AVE, RIVERSIDE, CA 92506-3163
(951) 369-5714
Mailing address
6355 RIVERSIDE AVE, RIVERSIDE, CA 92506-3163
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
02/04/2008
Last updated
02/04/2008
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