Individual
KESHIA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
680 COLUMBUS RD, CONCORD, VA 24538-3683
(434) 420-9957
Mailing address
680 COLUMBUS RD, CONCORD, VA 24538-3683
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
RBT-21-160304
VA
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
Other
Enumeration date
07/06/2021
Last updated
06/13/2023
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