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MR. KENNETH T JACKSON MASTERS
NPI 1639469026
Counselor - Addiction (Substance Use Disorder) in Warren, MI

Active since April 19, 2011
25506 VIRGINIA DR, WARREN, MI 48091(313) 492-5119 Get Directions Write a Review

NPPES record last updated: April 19, 2011. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Mr. Kenneth T Jackson Masters NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MR. KENNETH T JACKSON MASTERS (NPI 1639469026) is an individual addiction (substance use disorder) provider in Warren, Michigan and active in the NPI registry since April 2011.

NPPES Registry Identity

NPI1639469026
Entity TypeIndividualMale
Primary Taxonomy101YA0400X
Provider Legal NameMR. KENNETH T JACKSONCredential: MASTERS
Location Address25506 VIRGINIA DRWarren, MI 48091-6002
Mailing Address25506 Virginia DrWarren, MI 48091-6002 · (313) 492-5119
Phone(313) 492-5119
Sole ProprietorYes
Enumeration DateApril 19, 2011
✔ NPI 1639469026 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
25506 VIRGINIA DR, Warren, MI 48091
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Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kenneth Jackson's NPI number?

The NPI number for Kenneth Jackson is 1639469026. It was assigned to this individual provider in the NPPES registry on April 19, 2011.

Where is Kenneth Jackson located?

Kenneth Jackson practices at 25506 Virginia Dr, Warren, MI 48091. The listed phone number is (313) 492-5119.

What is Kenneth Jackson's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Addiction (Substance Use Disorder), with taxonomy code 101YA0400X.

When was this NPI record last updated?

The NPPES record for Kenneth Jackson was last updated on April 19, 2011. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.