Individual
ALVIN DAVE LACKARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3313 WASHINGTON ST, JAMAICA PLAIN, MA 02130-2691
(617) 522-7008
Mailing address
24 MARYLAND ST APT 2, DORCHESTER, MA 02125-4165
(860) 938-7205
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
07/17/2020
Last updated
07/17/2020
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