Individual
VALECIA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CSAC
Contact information
Practice address
420 PINE RIDGE RD, PETERSBURG, VA 23805-1320
(804) 714-5998
Mailing address
420 PINE RIDGE RD, PETERSBURG, VA 23805-1320
(804) 714-5998
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
0709024300
VA
101YM0800X
Mental Health Counselor
—
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0709024300
SUBSTANCE ABUSE
VA
05
—
0709024300
—
VA
Enumeration date
10/21/2021
Last updated
10/21/2021
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