Individual
MR. MICHAEL JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CASAC
Contact information
Practice address
1910 ARTHUR AVE, BRONX, NY 10457-6305
(718) 583-5150
(718) 731-2453
Mailing address
1910 ARTHUR AVE, BRONX, NY 10457-6305
(718) 583-5150
(718) 731-2453
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
19006
NY
Other
Enumeration date
10/29/2010
Last updated
01/25/2017
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