Individual
CHARLEY MARIE MOORE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
9403 KENWOOD RD, BLUE ASH, OH 45242-6895
(513) 543-6600
(513) 745-0037
Mailing address
9403 KENWOOD RD, BLUE ASH, OH 45242-6895
(513) 543-6600
(513) 745-0037
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
03/04/2020
Last updated
03/04/2020
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