Organization
EPIPHANY PSYCHOTHERAPY & CONSULTATION, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. D'ANDRIA A. A JACKSON PSY.D (OWNER/LICENSED CLINICAL PSYCHOLOGIS)
(614) 665-5100
Entity
Organization
Contact information
Practice address
341 S 3RD ST STE 100-344, COLUMBUS, OH 43215-5463
(614) 665-5100
(855) 844-8447
Mailing address
1739 COTTONWOOD DR, LEWIS CENTER, OH 43035-7937
(202) 439-6469
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1285044776
INDIVIDUAL NPI
VA
Enumeration date
08/11/2020
Last updated
08/11/2020
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