Individual
TANJA DECARLO-JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1400 E 12 MILE RD, MADISON HEIGHTS, MI 48071-2651
(248) 547-2223
Mailing address
19134 MONTROSE ST, DETROIT, MI 48235-2309
(313) 653-4652
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
MI
Other
Enumeration date
05/22/2007
Last updated
07/08/2007
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