Individual
MR. JOHN JAMES JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMSW
Contact information
Practice address
248 W 108TH ST, NEW YORK, NY 10025-2956
(212) 663-3000
(212) 663-3179
Mailing address
248 W 108TH ST, NEW YORK, NY 10025-2956
(212) 663-3000
(212) 663-3179
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
7509484
NY
Other
Enumeration date
05/15/2013
Last updated
05/15/2013
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