Individual
JACKSON PALMORE HARRELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
11240 WAPLES MILL RD STE 101, FAIRFAX, VA 22030-6078
(703) 237-2219
(703) 237-2729
Mailing address
10211 LESLIE CT APT 304, BURKE, VA 22015-4682
(703) 581-4632
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
04/03/2018
Last updated
04/03/2018
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