Individual
DOMONIQUE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
752 BLANDING BLVD STE 130, ORANGE PARK, FL 32065-5790
(904) 637-5297
Mailing address
3045 RUSSELL RD, GREEN COVE SPRINGS, FL 32043-8209
(904) 505-1844
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
02/02/2017
Last updated
06/25/2020
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