Individual
ALVIN GLEN JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
495 EAST MAIN STREET, COLUMBUS, OH 43215
(614) 355-8055
Mailing address
PO BOX 78000 DEPT 7816125, DETROIT, MI 48278-1625
(614) 355-8004
(614) 722-4565
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
C.1700707
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1473276
—
OH
Enumeration date
07/21/2017
Last updated
11/19/2019
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