Individual
AMANDA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
815 W BROAD ST STE 200, COLUMBUS, OH 43222-1465
(614) 717-0822
Mailing address
3180 DRAKE AVE, GROVEPORT, OH 43125-9006
(614) 625-4266
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CDCA194264
OH
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
09/21/2021
Last updated
01/12/2026
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