Most Relevant Information
Provider Data
| NPI Number: | 1003588476 |
| Provider Name: | DAREL JACKSON |
| Entity Type: | Individual |
| Taxonomy Code: | 101Y00000X |
| Specialty: | Counselor |
| License Number: | CDCA.175418 |
Most Important Dates
| Enumeration Date: | 10/04/2021 |
| Last Updated: | 10/04/2021 |
Provider Practice Location
16 W LONG ST
COLUMBUS
OH
432152815
Practice Location Phone/Fax
| Phone: | 6148091393 |
| Fax: |
Provider Mailing Location
16 W LONG ST
COLUMBUS
OH
432152815
Provider Mailing Phone/Fax
| Phone: | 6148091393 |
| Fax: |