MS. SANDRA J JACKSON LCAC CADAC IV NADAC
NPI 1124449053
Counselor - Addiction (Substance Use Disorder) in South Bend, IN
Active since December 19, 2013
About Ms. Sandra J Jackson Lcac Cadac Iv Nadac NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
MS. SANDRA J JACKSON LCAC CADAC IV NADAC (NPI 1124449053) is an individual addiction (substance use disorder) provider in South Bend, Indiana, licensed in Indiana (88000353A) and active in the NPI registry since December 2013.
NPPES Registry Identity
NPI1124449053
Entity TypeIndividualFemale
Primary Taxonomy101YA0400X
Provider Legal NameMS. SANDRA J JACKSONCredential: LCAC CADAC IV NADAC
Location Address4218 WESTERN AVE.South Bend, IN 46619
Mailing Address4218 Western Ave.South Bend, IN 46619 · (574) 274-1524 · Fax (574) 274-1612
Phone(574) 233-1524
Sole ProprietorNo
Enumeration DateDecember 19, 2013
✔ NPI 1124449053 is a valid, active identifier and passes the ISO check-digit test.
Specialties & Licenses
★ Primary SpecialtyCounselor · Addiction (Substance Use Disorder)Behavioral Health & Social Service Providers
Taxonomy Code101YA0400X
License✔ Licensed in IN · 88000353A
4218 WESTERN AVE., South Bend, IN 46619
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1124449053, enumerated as an "individual" on December 19, 2013.
The provider is located at 4218 WESTERN AVE. SOUTH BEND, IN 46619 and the phone number is (574) 233-1524.
Counselor with taxonomy code 101YA0400X and a focus in Addiction (Substance Use Disorder).
