Individual
TAMARA T JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
40 JEFFERSON AVE SE, GRAND RAPIDS, MI 49503-4304
(616) 456-1443
Mailing address
40 JEFFERSON AVE SE, GRAND RAPIDS, MI 49503-4304
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
12/26/2019
Last updated
12/26/2019
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