Individual
MR. ISAAC L. JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCAS-A
Contact information
Practice address
113 W ELWOOD AVE, RAEFORD, NC 28376-2801
(910) 848-1638
(910) 848-1639
Mailing address
113 W ELWOOD AVE, RAEFORD, NC 28376-2801
(910) 848-1638
(910) 848-1639
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
2199-A
NC
Other
Enumeration date
10/01/2012
Last updated
10/01/2012
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