Individual
COLIN JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LSW
Contact information
Practice address
395 S CENTER ST, ORANGE, NJ 07050-3205
(973) 323-3909
Mailing address
36 MOUNTAIN AVE, MAPLEWOOD, NJ 07040-2542
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
44SL06983800
NJ
Other
Enumeration date
02/23/2024
Last updated
02/23/2024
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