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Individual
JERRONTAY JACKSON
Active
Individual
JERRONTAY JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMSW
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
0733007407
VA
1041C0700X
Clinical Social Worker
Primary
0906017686
VA
Other
Enumeration date
08/05/2020
Last updated
06/17/2026
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