Individual
DIANA M JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
341 E G ST, PURCELLVILLE, VA 20132-3326
(240) 446-9852
Mailing address
341 E G ST, PURCELLVILLE, VA 20132-3326
(240) 446-9852
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
0704013604
VA
Other
Enumeration date
07/24/2023
Last updated
07/24/2023
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