Individual
JEANETTE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COUNSELOR
Contact information
Practice address
1300 AVENUE P, BROOKLYN, NY 11229-1106
(718) 954-3800
(718) 954-3767
Mailing address
1118 DECATUR ST, BROOKLYN, NY 11207-1128
(347) 233-9985
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
21300
NY
Other
Enumeration date
08/21/2009
Last updated
08/21/2009
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