Individual
MS. ANDREA DANIELLE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BT
Contact information
Practice address
709 QUINCE PL, CHESAPEAKE, VA 23320-0769
(309) 212-5021
Mailing address
709 QUINCE PL, CHESAPEAKE, VA 23320-0769
(309) 212-5021
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
08/17/2023
Last updated
08/17/2023
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