Individual
ITASHA VERONICA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
1400 BLACKHORSE HILL RD, COATESVILLE, PA 19320-2040
(484) 266-9785
(610) 466-2229
Mailing address
73 PROVIDENCE FORGE RD, ROYERSFORD, PA 19468-2934
(516) 238-6160
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
081529-1
NY
104100000X
Social Worker
Primary
SW132795
PA
Other
Enumeration date
09/03/2008
Last updated
08/25/2020
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