Individual
MR. CHRISTOPHER LADD JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MC, LPC, LISAC, NCGC
Contact information
Practice address
12301 W BELL RD STE A102, SURPRISE, AZ 85374-9707
(602) 614-5926
(623) 583-3888
Mailing address
PO BOX 7164, SURPRISE, AZ 85374
(602) 614-5926
(623) 583-3888
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
LISAC-11483
AZ
101YP2500X
Professional Counselor
Primary
LPC-12267
AZ
Other
Enumeration date
12/10/2007
Last updated
02/12/2009
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