Individual
RICHARD CHAD JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1 TRILLIUM WAY, CORBIN, KY 40701-8426
(606) 523-8521
Mailing address
920 BARGO ST, LONDON, KY 40741-2710
(606) 878-7658
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
311
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C62048
CUMBERLAND HEALTHCARE INC
KY
Enumeration date
04/24/2007
Last updated
07/08/2007
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