Individual
MR. JACK WEAVER JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ALC
Contact information
Practice address
521 GAULT AVE N, FORT PAYNE, AL 35967-2307
(256) 273-7216
Mailing address
521 GAULT AVE N, FORT PAYNE, AL 35967-2307
(256) 273-7216
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
C2207A
AL
Other
Enumeration date
12/03/2013
Last updated
12/03/2013
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