Individual
MR. COURTNEY LARESIC JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
608 10TH ST, SACRAMENTO, CA 95814-0712
(916) 441-2933
Mailing address
3372 RIVERMONT ST, WEST SACRAMENTO, CA 95691-5443
(916) 371-9338
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
03/29/2007
Last updated
07/08/2007
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