Individual
JACKIE RE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCADC
Contact information
Practice address
100 MOHICAN RD, BLAIRSTOWN, NJ 07825-9687
(908) 295-8097
Mailing address
100 MOHICAN RD, BLAIRSTOWN, NJ 07825-9687
(908) 295-8097
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
37LC00325900
NJ
Other
Enumeration date
02/23/2021
Last updated
02/23/2021
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