Individual
DORIS VIDAL DE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
2201 CHAPEL AVE W, CHERRY HILL, NJ 08002-2048
(856) 428-4357
(856) 665-5193
Mailing address
19 E ORMOND AVE, CHERRY HILL, NJ 08034-2053
(856) 428-1300
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
44SC00270500
NJ
Other
Enumeration date
08/17/2011
Last updated
08/17/2011
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