Individual
JOHN ARCHIE JACKSON JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
209 MARTIN LUTHER KING DR, ELIZABETHTOWN, NC 28337
(910) 247-6822
(910) 247-6829
Mailing address
12500 ORMSBY DR, LAURINBURG, NC 28352-7770
(910) 318-4008
(910) 247-6829
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1917
NC
Other
Enumeration date
10/23/2019
Last updated
10/23/2019
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