Individual
JAMES JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
103 COMMERCIAL ST, BROCKTON, MA 02302-3101
(508) 521-1020
Mailing address
48 TABER AVE, BROCKTON, MA 02302-2341
(774) 462-9195
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
101YM0800X
Mental Health Counselor
—
—
Other
Enumeration date
09/28/2015
Last updated
09/28/2015
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