Individual
ULYSSES JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
89 WASHINGTON AVE, DEER PARK, NY 11729-6917
(631) 767-9294
(631) 767-9294
Mailing address
89 WASHINGTON AVE, DEER PARK, NY 11729-6917
(631) 767-9294
(631) 767-9294
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
24980
NY
Other
Enumeration date
04/15/2014
Last updated
11/10/2025
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