Individual
ALYX JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CDCA
Contact information
Practice address
303 GERVAIS RD, FRANKLIN FURNACE, OH 45629-8742
(740) 259-7000
(740) 259-7003
Mailing address
303 GERVAIS RD, FRANKLIN FURNACE, OH 45629-8742
(740) 259-7000
(740) 259-7003
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CDCA.172454
OH
171M00000X
Case Manager/Care Coordinator
CDCA.172454
OH
Other
Enumeration date
01/22/2020
Last updated
01/22/2020
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