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Individual

LATRELLE JACKSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PHD

Contact information

Practice address
9702 GAYTON RD, #181, RICHMOND, VA 23238-4907
(804) 741-7500
(804) 741-7900
Mailing address
9702 GAYTON RD, #181, RICHMOND, VA 23238-4907
(804) 741-7500
(804) 741-7900

Taxonomy

Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
0810003414
VA

Other

Enumeration date
08/23/2007
Last updated
11/11/2008
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