Organization
USAF
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DARLON JACKSON CREDENTIALS MANAGER (CREDENTIALS MANAGER)
(210) 292-6707
Entity
Organization
Contact information
Practice address
2200 BERQUIST DRIVE, SUITE 1, ATTN: CREDENTIALS, JBSA-LACKLAND, TX 78236-9908
(210) 292-6707
Mailing address
2200 BERQUIST DRIVE, SUITE 1, ATTN: CREDENTIALS, JBSA-LACKLAND, TX 78236-9908
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
Other
Enumeration date
11/18/2016
Last updated
11/18/2016
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