Individual
JUSTICE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2820 WATERFORD LAKE DR STE 102, MIDLOTHIAN, VA 23112-3994
(804) 562-6604
(757) 970-0277
Mailing address
6800 PARAGON PL STE 200, RICHMOND, VA 23230-1652
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-22-245110
VA
Other
Enumeration date
12/05/2022
Last updated
12/05/2022
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