Individual
JULIAN MYLES JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1258 HOLLAND RD, SUFFOLK, VA 23434-6313
(877) 848-9810
Mailing address
622 HORSE CAMP LN, CHESAPEAKE, VA 23323-5933
(302) 494-5019
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
VA
Other
Enumeration date
09/22/2025
Last updated
09/22/2025
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