Individual
JUSTIN JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
4212 PARK PLACE CT, GLEN ALLEN, VA 23060-3314
(804) 332-5950
(804) 728-1086
Mailing address
4212 PARK PLACE CT, GLEN ALLEN, VA 23060-3314
(804) 332-5950
(804) 728-1086
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
0701008565
VA
101YA0400X
Addiction (Substance Use Disorder) Counselor
0701008565
VA
101YM0800X
Mental Health Counselor
0701008565
VA
101YP2500X
Professional Counselor
Primary
0701008565
VA
Other
Enumeration date
09/05/2019
Last updated
08/20/2021
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