Individual
DAVID ALEXANDER JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PRSS
Contact information
Practice address
1303 WASHINGTON ST W, CHARLESTON, WV 25302-1333
(304) 553-0010
(304) 699-2141
Mailing address
1303 WASHINGTON ST W, CHARLESTON, WV 25302-1333
(304) 553-0010
(304) 699-2141
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
23-977
WV
Other
Enumeration date
04/26/2023
Last updated
04/26/2023
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