Individual
DIANE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
9416 CREEK SUMMIT CIR, RICHMOND, VA 23235-4277
(804) 819-4000
(804) 819-5221
Mailing address
9416 CREEK SUMMIT CIR, RICHMOND, VA 23235-4277
(804) 819-4000
(804) 819-5221
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0904007697
VA
Other
Enumeration date
11/03/2011
Last updated
07/25/2014
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