Jackson, Cornell Lee

Jackson, Cornell Lee is an sole proprietor health care provider with primary practice located at 1852 W Grand Blvd , Detroit MI 48208-1006. He recently has only one registered license in Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), which is considered as his primary health care specialty. Jackson, Cornell Lee can be contacted via phone (313) 894-8444.

Contact Information

Primary practice address
1852 W Grand Blvd Detroit MI 48208-1006
Phone: (313) 894-8444
Fax: (313) 894-5542
Website:
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Health care specialties

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

Profile Details

NPI number 1851630461
LBN Legal business name Jackson, Cornell Lee
Credentials
Entity Individual
Sole proprietor 1 Yes
Enumeration date Feb 4th, 2013
Last updated Feb 4th, 2013 - about 13 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 1851630461 NPPES
Michigan MEDICAID 381917278

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