Individual
DAI JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
QMHS
Contact information
Practice address
13422 KINSMAN RD, CLEVELAND, OH 44120-4410
(216) 283-4400
(216) 283-5359
Mailing address
17210 DEFOREST AVE, CLEVELAND, OH 44128-2516
(216) 283-4400
(216) 283-5359
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
—
OH
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
04/12/2018
Last updated
11/16/2018
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