Individual
MRS. VAGILLIA FAYE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
545 ST ANNES PL, COVINGTON, GA 30016-4123
(407) 557-6255
Mailing address
545 ST ANNES PL, COVINGTON, GA 30016-4123
(407) 557-6255
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
MSW008760
GA
Other
Enumeration date
08/27/2019
Last updated
08/27/2019
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