Individual
MR. JACK D WOODBURN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
1101 MILITARY ST, PORT HURON, MI 48060-5418
(810) 984-5575
(810) 984-6433
Mailing address
1101 MILITARY ST, PORT HURON, MI 48060-5418
(810) 984-5575
(810) 984-6433
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
6401000326
MI
Other
Enumeration date
07/02/2008
Last updated
07/02/2008
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