Individual
NANNIE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
9201 N 5TH ST, PHOENIX, AZ 85020-2532
(602) 331-5792
(602) 331-7855
Mailing address
2500 W UTOPIA RD, SUITE 100, PHOENIX, AZ 85027-4171
(623) 434-6200
(623) 434-6164
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LISAC 11861
AZ
Other
Enumeration date
10/15/2015
Last updated
10/15/2015
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