Individual
JACK DYLAN MARCHANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CDCII
Contact information
Practice address
5594 AISEK STREET, JUNEAU, AK 99801-9980
(907) 780-3048
Mailing address
5597 AISEK ST, JUNEAU, AK 99801-9522
(907) 780-3048
(907) 780-6083
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
CDCA.170840
OH
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
101YP2500X
Professional Counselor
—
—
Other
Enumeration date
08/31/2017
Last updated
02/20/2023
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