Individual
CATHLEEN JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CASAC,ICADC
Contact information
Practice address
490 E RIDGE RD, ROCHESTER, NY 14621-1229
(585) 922-2588
Mailing address
4557 LINCOLN RD, MACEDON, NY 14502-9314
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
16639
NY
Other
Enumeration date
01/19/2010
Last updated
09/16/2011
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