Individual
DIAMOND DANDRIA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1104A S MAIN ST, LEXINGTON, NC 27292-3134
(336) 300-8836
Mailing address
284 EXECUTIVE PARK DR STE 100, CONCORD, NC 28025-1833
(704) 939-1100
(704) 939-1173
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
P018693
NC
Other
Enumeration date
03/21/2023
Last updated
04/12/2023
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