Individual
DIANE T. JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LSW
Contact information
Practice address
6100 CHANNINGWAY BLVD STE 206, COLUMBUS, OH 43232-2910
(614) 706-5099
(614) 725-0402
Mailing address
5871 RIVERTON RD, COLUMBUS, OH 43232-1650
(614) 285-1355
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
S.2309785
OH
Other
Enumeration date
09/12/2023
Last updated
09/12/2023
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