Individual
MR. TIMOTHY WILLIAM JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.A., CASAC
Contact information
Practice address
115 LIBERTY ST, BATH, NY 14810-1508
(607) 664-2152
Mailing address
115 LIBERTY ST, BATH, NY 14810-1508
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
04/19/2010
Last updated
03/16/2016
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