Individual
KEIRA MICHELLE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
8601 ROSE MALLOW DR APT 415, MANASSAS, VA 20109-4025
(757) 232-9100
Mailing address
8601 ROSE MALLOW DR APT 415, MANASSAS, VA 20109-4025
(757) 232-9100
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
0710103585
VA
101YM0800X
Mental Health Counselor
Primary
0704014248
VA
Other
Enumeration date
01/21/2019
Last updated
10/14/2022
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