Individual
JOSEPH JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCDC II
Contact information
Practice address
158 W MAIN ST, ANDOVER, OH 44003-9318
(216) 800-8700
Mailing address
158 W MAIN ST, ANDOVER, OH 44003-9318
(216) 800-8700
(216) 353-4804
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
LCDCII.162062
OH
175T00000X
Peer Specialist
PRS.007460
OH
324500000X
Substance Abuse Rehabilitation Facility
Primary
167972
OH
Other
Enumeration date
08/27/2018
Last updated
04/07/2026
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