person
Charlesetta Jackson, SAC
Addiction (Substance Use Disorder) Counselor in Milwaukee, Wisconsin
NPI 1922273879

Charlesetta Jackson is an Addiction (Substance Use Disorder) Counselor based in Milwaukee, WI and is specialized in Addiction (Substance Use Disorder). Charlesetta Jackson practices in Milwaukee, WI and has the professional credentials of SAC. The NPI Number for Charlesetta Jackson is 1922273879 and holds a License No. 15371-131 (Wisconsin).

The current practice location address for Charlesetta Jackson is 4757 N 76Th St, Milwaukee, WI and can be reached out via phone at 414-358-4171 and via fax at 414-358-5005.

Location: 4757 N 76Th St, Milwaukee, WI, 53218-4732
person
Provider Profile Details
NPI Number
1922273879
Provider Name
Charlesetta Jackson
Credential
SAC
Provider Entity Type
Individual
Gender
Female
Address
4757 N 76Th St, Milwaukee, WI, 53218-4732
Phone Number
414-358-4171
Fax Number
414-358-5005
Provider Enumeration Date
04/22/2008
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
15371-131 01 WI DEPARTMENT OF REGULATION & LICENSING
39178900-31/048 05 WI
institution
Provider Business Practice Location Address Details
Address
4757 N 76Th St
City
State
Zip
53218-4732
Phone Number
414-358-4171
Fax Number
414-358-5005
person
Provider Business Mailing Address Details
Address
4757 N 76Th St
City
State
Zip
53218-4732
Phone Number
414-358-4171
Fax Number
414-358-5005
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Addiction (Substance Use Disorder)
Taxonomy
License No.
15371-131 (Wisconsin)
Definition
Definition to come...
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