Individual
JAMAR JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
12531 CLIPPER DR STE 201, WOODBRIDGE, VA 22192-2355
(571) 427-2983
Mailing address
12531 CLIPPER DR STE 201, WOODBRIDGE, VA 22192-2355
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
18-55268
REGISTERED BEHAVIOR TECHNICIAN
VA
Enumeration date
06/18/2021
Last updated
06/18/2021
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