Individual
DR. STACEY MARIE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
701 HOSPITAL LOOP, FAIRCHILD AFB, WA 99011-8704
(509) 247-3852
Mailing address
11 NEALY BLVD, HAMPTON, VA 23665-2023
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
08100006337
VA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
08/14/2017
Last updated
08/15/2023
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