John Archie Jackson Jr.
Counselor, Addiction (Substance Use Disorder) in Elizabethtown, NC. Individual provider (NPI-1).
NPI number1801439799
StatusActive
Last updated in NPPESOct 23, 2019
Details
- NPI
- 1801439799
- Entity type
- Individual (NPI-1)
- Name
- John Archie Jackson Jr.
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Oct 23, 2019
- Last updated
- Oct 23, 2019
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 101YA0400X | Counselor, Addiction (Substance Use Disorder) | 1917 | NC | Yes |
Practice location
209 Martin Luther King DrElizabethtown, NC 28337
Phone 910-247-6822 · Fax 910-247-6829
Mailing address
12500 Ormsby DrLaurinburg, NC 28352-7770
Phone 910-318-4008 · Fax 910-247-6829
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