Individual
ANTOINE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
401 S TUSTIN ST, ORANGE, CA 92866-2550
(714) 289-3936
Mailing address
2185 W COLLEGE AVE APT 3018, SAN BERNARDINO, CA 92407-7027
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
06/26/2018
Last updated
06/26/2018
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