Individual
JACKSON THOMAS STREITWIESER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCAS, LCMHC-A
Contact information
Practice address
315 E WASHINGTON ST, GREENSBORO, NC 27401-2911
(336) 387-6161
Mailing address
PO BOX 19305, CHARLOTTE, NC 28219-9305
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
LCAS-26174
NC
101YP2500X
Professional Counselor
Primary
A17081
NC
Other
Enumeration date
11/03/2021
Last updated
08/19/2024
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