Individual
JACKLYN SIMON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC, CSOTP, CCTP
Contact information
Practice address
4901 E PATRICK HENRY HWY, BURKEVILLE, VA 23922-3454
(434) 767-7801
Mailing address
1499 LEW JONES RD, ALBERTA, VA 23821-2609
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
0701006044
VA
Other
Enumeration date
04/03/2020
Last updated
04/03/2020
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