Individual
CRYSTAL JACKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
411 COURT ST, PORTSMOUTH, OH 45662-3932
(740) 354-6685
Mailing address
411 COURT ST, PORTSMOUTH, OH 45662-3932
(740) 354-6685
(740) 876-4005
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
Other
Enumeration date
08/03/2023
Last updated
08/03/2023
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