Individual
DESTINEE MONET JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
200 N 22ND ST, RICHMOND, VA 23223-7020
(804) 644-9590
Mailing address
200 N 22ND ST, RICHMOND, VA 23223-7020
(804) 644-9590
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
0906010426
VA
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
10/30/2020
Last updated
11/11/2020
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