Willie Lee Jackson Jr.
Counselor, Addiction (Substance Use Disorder) in Los Angeles, CA. Individual provider (NPI-1).
NPI number1013143395
StatusActive
Last updated in NPPESJun 1, 2009
Details
- NPI
- 1013143395
- Entity type
- Individual (NPI-1)
- Name
- Willie Lee Jackson Jr.
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Jun 1, 2009
- Last updated
- Jun 1, 2009
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 101YA0400X | Counselor, Addiction (Substance Use Disorder) | – | – | Yes |
Practice location
157 Santa Barbara PlzLos Angeles, CA 90008-2508
Phone 323-293-2717
Mailing address
157 Santa Barbara PlzLos Angeles, CA 90008-2508
Phone 323-293-2717
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