Organization
CONTROLLED OUTCOMES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRIAN KEITH JACKSON PHD (MANAGING PARTNER)
(804) 415-8106
Entity
Organization
Contact information
Practice address
3714 RUFFIN RD, NORTH PRINCE GEORGE, VA 23860-8629
(804) 415-8106
(804) 415-8106
Mailing address
3714 RUFFIN RD, NORTH PRINCE GEORGE, VA 23860-8629
(804) 415-8106
(804) 415-8106
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
251V00000X
Voluntary or Charitable Agency
—
—
Other
Enumeration date
12/28/2016
Last updated
12/28/2016
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