Individual
CATHERINE ELIZABETH JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
24805 PINEBROOK RD STE 312, CHANTILLY, VA 20152-4128
(703) 496-4371
Mailing address
641 LEGACY HERITAGE LN APT 101, WAKE FOREST, NC 27587-3129
(919) 896-0927
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
BACB-965034
VA
106S00000X
Behavior Technician
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Other
Enumeration date
05/20/2024
Last updated
05/20/2024
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