Individual
MR. JACKSON LUFUAKIADI NSILULU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
P.C, AND L.I.C.D.C.
Contact information
Practice address
313 VERDON PL, TROTWOOD, OH 45426-2754
(937) 286-3886
Mailing address
313 VERDON PLACE, TROTWOOD, OH 45426
(937) 286-3886
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
0007453
OH
101YA0400X
Addiction (Substance Use Disorder) Counselor
991504
OH
101YM0800X
Mental Health Counselor
0007453
OH
101YP2500X
Professional Counselor
Primary
0007453
OH
103K00000X
Behavior Analyst
0007453
OH
Other
Enumeration date
08/16/2011
Last updated
08/16/2011
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