Individual
MR. THOMAS ADDISON JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPRS QMHP-A
Contact information
Practice address
652 W FREDERICK ST, STAUNTON, VA 24401-3103
(434) 249-0851
(434) 218-0530
Mailing address
652 W FREDERICK ST, STAUNTON, VA 24401-1303
(434) 249-0851
(434) 218-0530
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
02/03/2016
Last updated
03/12/2021
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