person
Mr. Cornell Lee Jackson
Addiction (Substance Use Disorder) Counselor in Detroit, Michigan
NPI 1851630461

Cornell Lee Jackson is an Addiction (Substance Use Disorder) Counselor based in Detroit, MI and is specialized in Addiction (Substance Use Disorder). Cornell Lee Jackson practices in Detroit, MI. The NPI Number for Cornell Lee Jackson is 1851630461 and holds a License No. (Michigan).

The current practice location address for Cornell Lee Jackson is 1852 W Grand Blvd, Detroit, MI and can be reached out via phone at 313-894-8444 and via fax at 313-894-5542.

Location: 1852 W Grand Blvd, Detroit, MI, 48208-1006
person
Provider Profile Details
NPI Number
1851630461
Provider Name
Cornell Lee Jackson
Credential
Provider Entity Type
Individual
Gender
Male
Address
1852 W Grand Blvd, Detroit, MI, 48208-1006
Phone Number
313-894-8444
Fax Number
313-894-5542
Provider Enumeration Date
02/04/2013
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
381917278 05 MI
institution
Provider Business Practice Location Address Details
Address
1852 W Grand Blvd
City
State
Zip
48208-1006
Phone Number
313-894-8444
Fax Number
313-894-5542
person
Provider Business Mailing Address Details
Address
1852 W Grand Blvd
City
State
Zip
48208-1006
Phone Number
313-894-8444
Fax Number
313-894-5542
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Addiction (Substance Use Disorder)
Taxonomy
License No.
()
Definition
Definition to come...
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