Individual
MS. SANDRA J JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCAC CADAC IV NADAC
Contact information
Practice address
4218 WESTERN AVE., SOUTH BEND, IN 46619
(574) 233-1524
Mailing address
4218 WESTERN AVE., SOUTH BEND, IN 46619
(574) 274-1524
(574) 274-1612
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
88000353A
IN
Other
Enumeration date
12/19/2013
Last updated
12/19/2013
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