Individual
JACKIE LEE FORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CDP
Contact information
Practice address
4324 N JEFFERSON ST, SPOKANE, WA 99205-1209
(509) 315-8682
Mailing address
4324 N JEFFERSON ST, SPOKANE, WA 99205-1209
(509) 315-8682
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
WA
Other
Enumeration date
10/03/2018
Last updated
10/03/2018
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