Organization
KEYSTONE DJJ, LLC
Active
Other names
Bristol Youth Academy
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JEANETTE JACKSON LCSW (PROGRAM DIRECTOR)
(850) 643-4600
Entity
Organization
Contact information
Practice address
12422 NW G T REVELL RD, BRISTOL, FL 32321-3007
(850) 643-4600
(850) 643-2061
Mailing address
12422 NW G T REVELL RD, BRISTOL, FL 32321-3007
(850) 643-4600
(850) 643-2061
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0239AD272501
OUTPATIENT SUBSTANCE ABUS
FL
Enumeration date
11/05/2007
Last updated
06/14/2008
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