# JACKSON PROFESSIONAL SERV LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Valecia Jackson
- **Organization subpart:** No

## Provider details

- **NPI number:** 1922761352
- **Authorized official:** ANTOINITA C STOKES (CONSULTANT)
- **Authorized official phone:** (804) 613-0087

## Contact information

- **Practice address:** 420 PINE RIDGE RD, PETERSBURG, VA 23805-1320
- **Practice address phone:** (804) 714-5998
- **Mailing address:** 420 PINE RIDGE RD, PETERSBURG, VA 23805-1320

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | NULL | Yes |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | — | Yes |
| 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