Individual
DENISE DIANE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4298 ROCKY RIVER DR, CLEVELAND, OH 44135-1951
(216) 526-4729
(216) 781-2252
Mailing address
4298 ROCKY RIVER DR, CLEVELAND, OH 44135-1951
(216) 526-4729
(216) 781-2252
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
164132
OH
Other
Enumeration date
12/27/2017
Last updated
01/26/2023
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