Individual
KENDALL JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
133 HEDRICK DR, SUGAR GROVE, WV 26815-5068
(310) 910-0406
Mailing address
133 HEDRICK DR, SUGAR GROVE, WV 26815-5068
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
06/05/2026
Last updated
06/05/2026
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