Individual
DENERA RENAE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3204 SUMMER PL # 2, GREENVILLE, NC 27834-7043
(252) 717-7401
Mailing address
3204 SUMMER PL # 2, GREENVILLE, NC 27834-7043
(252) 717-7401
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
10/23/2023
Last updated
10/23/2023
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