Individual
TERRANCE LAMONT JACKSON SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2155 GEORGETOWN RD NE, CANTON, OH 44704-2257
(816) 377-7225
Mailing address
2155 GEORGETOWN RD NE, CANTON, OH 44704-2257
(816) 377-7225
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
305S00000X
Point of Service
Primary
—
—
Other
Enumeration date
08/07/2023
Last updated
08/07/2023
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