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NPI Code Detail

MEDICARE: SIMONE RENE JACKSON MAS (AJS)

MEDICARE: SIMONE RENE JACKSON MAS (AJS)
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1205214988
Entity Type Code : Individual
Provider Name (Legal Business Name) : SIMONE RENE JACKSON MAS (AJS)
Provider Business Mailing Address
First Line : 6511 DUPONT ST
Second Line :
City : FLINT
State : MI
Zip : 48505-2068
Country : US
Telephone Number : 810-348-3303
Fax Number : 810-733-7623
Provider Business Practice Location Address
First Line : 1044 GILBERT ST
Second Line :
City : FLINT
State : MI
Zip : 48532-3527
Country : US
Telephone Number : 810-422-9406
Fax Number : 810-733-7623
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/13/2015
Last Update Date : 05/13/2015

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Directions to “ SIMONE RENE JACKSON MAS (AJS)” Practice Location

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