Individual
DOMINIQUE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
20 S 3RD ST STE 210, PMB 1971281, COLUMBUS, OH 43215-4206
(614) 815-2490
Mailing address
20 S 3RD ST STE 210, PMB 1971281, COLUMBUS, OH 43215-4206
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
253Z00000X
In Home Supportive Care Agency
—
—
374J00000X
Doula
Primary
—
—
Other
Enumeration date
10/07/2024
Last updated
10/07/2024
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