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Organization
JACKSON PROFESSIONAL SERV LLC
Active
Organization
JACKSON PROFESSIONAL SERV LLC
Active
Other names
Valecia Jackson
Organization subpart
No
Provider details
NPI number
Authorized official
ANTOINITA C STOKES (CONSULTANT)
(804) 613-0087
Entity
Organization
Contact information
Practice address
420 PINE RIDGE RD, PETERSBURG, VA 23805-1320
(804) 714-5998
Mailing address
420 PINE RIDGE RD, PETERSBURG, VA 23805-1320
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
NULL
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
101YM0800X
Mental Health Counselor
—
NULL
101YM0800X
Mental Health Counselor
—
—
172V00000X
Community Health Worker
—
NULL
172V00000X
Community Health Worker
—
—
251S00000X
Community/Behavioral Health Agency
—
NULL
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
NULL
Other
Enumeration date
10/21/2021
Last updated
10/21/2021
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