Individual
MRS. JACQUELINE R. JOHN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW
Contact information
Practice address
4520 N CENTRAL AVE STE 600, PHOENIX, AZ 85012-1848
(602) 254-3247
(602) 424-1623
Mailing address
4520 N CENTRAL AVE STE 100, PHOENIX, AZ 85012-1831
(602) 254-3247
(602) 424-1623
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
600467306
MAGELLAN
AZ
Enumeration date
10/28/2008
Last updated
10/28/2008
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