Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Mr. Kenneth T Jackson, MASTERS

Individual provider Addiction (Substance Use Disorder) Counselor · NPI 1639469026

Mr. Kenneth T Jackson, MASTERS is an Addiction (Substance Use Disorder) Counselor in Warren, Michigan. Practices as a sole proprietor. Licensed in Michigan.

Licensed in
MI
In the registry since
2011

Practice location Address checks out

25506 Virginia Dr
Warren, MI 48091-6002
Phone: (313) 492-5119
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Addiction (Substance Use Disorder) Counselor (primary) Taxonomy 101YA0400X (MI)

Record details

NPI number1639469026
Entity typeIndividual (Type 1)
GenderMale
Credentials MASTERS
Sole proprietorYes
NPI enumeratedApril 19, 2011
Last updated in NPPESApril 19, 2011

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