Individual
MR. RODERICK O. JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
C.P.S.S.
Contact information
Practice address
211 GLENDALE ST, HIGHLAND PARK, MI 48203-3231
(313) 459-4802
Mailing address
9176 DIXIE, REDFORD, MI 48239-1516
(313) 459-4802
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
09/25/2009
Last updated
09/25/2009
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