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Individual

MR. BLAIRE JACKSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
CAC

Contact information

Practice address
5707 N 22ND ST, TAMPA, FL 33610-4350
(813) 239-8069
(813) 239-8514
Mailing address
5707 N 22ND ST, TAMPA, FL 33610-4350
(813) 239-8069
(813) 239-8514

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CAC 1335
LA

Other

Enumeration date
05/08/2012
Last updated
07/14/2015
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