Individual
MS. JACQUELIN ANTOINETTE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
11240 WAPLES MILL RD, 101, FAIRFAX, VA 22030-6078
(703) 237-2219
Mailing address
11240 WAPLES MILL RD, 101, FAIRFAX, VA 22030-6078
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-11-8474
FL
Other
Enumeration date
12/09/2010
Last updated
08/03/2021
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