Individual
JEREMIAH RASHAD JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
14253 W ASTER DR, SURPRISE, AZ 85379-5505
(205) 420-8155
Mailing address
14253 W ASTER DR, SURPRISE, AZ 85379-5505
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
01/17/2022
Last updated
01/17/2022
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