Individual
STEPHEN JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRS, CPS
Contact information
Practice address
2755 PHILMONT AVE, HUNTINGDON VALLEY, PA 19006-5368
(267) 297-4116
(215) 947-0196
Mailing address
4635 E STILES ST, PHILADELPHIA, PA 19137-1119
(646) 469-0120
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
11/10/2023
Last updated
11/10/2023
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