Jackson, Charlotte L

Jackson, Charlotte L is an individual health care provider with primary practice located at 14733 S Telegraph Rd , Monroe MI 48161-9545. She recently has only one registered license in Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), which is considered as her primary health care specialty. Jackson, Charlotte L can be contacted via phone (734) 243-8707.

Contact Information

Primary practice address
14733 S Telegraph Rd Monroe MI 48161-9545
Phone: (734) 243-8707
Fax: (734) 243-8710
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X

Profile Details

NPI number 1356528590
LBN Legal business name Jackson, Charlotte L
Credentials MS
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 30th, 2008
Last updated Jan 30th, 2008 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1356528590 NPPES
Ohio MEDICAID 2604097

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