Individual
ANAIYA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
425 W WASHINGTON ST STE 4, SUFFOLK, VA 23434-5320
(757) 974-0972
Mailing address
826 PINE TREE CT, NEWPORT NEWS, VA 23608-1117
(948) 867-4525
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-25-484229
VA
Other
Enumeration date
01/30/2023
Last updated
11/27/2025
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